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Assistant Surgeons (State Health Programs)

Provider Type

  • Physicians

Counties Covered

  • Fresno
  • Kern  
  • Kings
  • Los Angeles
  • Madera
  • Riverside
  • Sacramento
  • San Bernardino
  • San Diego 
  • San Joaquin
  • Stanislaus
  • Tulare

Health Net's list of procedures eligible for assistant surgeon reimbursement is based in part on the Centers for Medicare and Medicaid Services (CMS) assistant surgeon policy. Assistant surgeon charges are not allowed for procedures denoted by CMS with indicator "1" or "assistant surgeon may not be paid" on the National Physician Fee Schedule.

Assistant surgeon claims are to be coded with modifier 80 for physicians and modifier AS for non-physicians. Reimbursement is 20 percent of the surgeon's allowable rate of reimbursement.

Health Net does not require documentation at the time of claim submission; however, in the event the claim is audited, documentation may be required.

Supporting Sources

  • CMS National Policy 
Last Updated: 08/05/2021