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Humana Updates Assistant Surgeon Reimbursement

Humana’s reimbursement policy for a physician acting as an assistant surgeon has changed for Humana commercial plans. Please note the following changes that are now effective:

  • Humana allows a physician assistant-surgeon service at 16 percent.
  • Physician assistant-surgeon services are identified by the addition of modifier 80, 81 or 82 to the service line on the claim.

Note: Only Humana commercial plans are affected by these changes. Humana Medicare Advantage plans currently allow 16 percent of the maximum amount allowable under the member’s plan. We previously posted this notification on Oct. 22, 2016, on the Claim Processing Edits page. The notification can be viewed here.

For more information and examples of how physician and nonphysician assistant-surgeon services are reimbursed, please review Humana’s payment policy on assistant-at-surgery reimbursement found on the Humana claims payment policies page, and search by key phrase “assistant at surgery.”