Back to Top Skip to main content the official website of the Military Health System (MHS) and the Defense Health Agency (DHA)

Utility Navigation Links

TRICARE Reimbursement Manual 6010.61-M, April 1, 2015
Chapter 1
Section 17
Assistant Surgeons
Issue Date:  April 5, 1989
Copyright:  CPT only © 2006 American Medical Association (or such other date of publication of CPT). All Rights Reserved.
Revision:  C-48, April 17, 2020
10040 - 69990, 92982, 92984, 92995, 92996, 92998
This policy is mandatory for reimbursement of services provided by either network or non-network providers. However, alternative network reimbursement methodologies are permitted when approved by the Defense Health Agency (DHA) and specifically included in the network provider agreement.
3.0  ISSUE
How are assistant surgeons to be reimbursed?
An assistant surgeon is a physician, dentist, podiatrist, certified physician assistant, nurse practitioner, or certified nurse midwife acting within the scope of their license, who actively assists the operating surgeon in the performance of a covered surgical service. Refer to Section 6 for information regarding reimbursement of certified physician assistants and nurse practitioners performing as assistant surgeons.
5.1  Services of an assistant surgeon are payable when:
5.1.1  The surgical procedure is of such complexity and seriousness as to warrant an assistant surgeon. The assistant surgeon’s services must be of the type that cannot be accomplished by operating room nurses or other such operating room personnel.
5.1.2  Interns, residents or other house staff are not available to provide the surgical assistance services in the specialty area required. This necessarily entails that the assistant be involved in the actual performance of the procedure, not simply in other, ancillary services. Since an assistant would, thus, be occupied during the surgical procedure, the assistant would not be available to perform (and thus, could not bill for) another surgical procedure during the same time period.
Note:  Standby assistant surgeon services are not reimbursed when the assistant surgeon does not actively participate in the surgery.
5.2  The allowable charge for an assistant surgeon (where such services are covered) is to be the lower of the billed charge or 16% of the prevailing charge for the surgery involved. When an assistant surgeon is involved in multiple surgery, the same procedures used for determining reimbursement for the primary surgeon shall be used in determining reimbursement for the assistant surgeon.
5.3  No payment may be made for an assistant surgeon when co-surgeons are reimbursed, see Section 16.
5.4  No payment shall be made for the services of an assistant surgeon who is not an otherwise authorized TRICARE provider. See TRICARE Policy Manual (TPM), Chapter 11.
5.5  No payment shall be made for the services of a surgical assistant not meeting the requirements of this section.
The 16% reimbursement methodology is effective for assistant surgeon services provided on or after November 1, 1993.
- END -

Utility Navigation Links

DoD Seal is the official website of the Defense Health Agency (DHA) a component of the Military Health System

TRICARE is a registered trademark of the Department of Defense (DoD), DHA. All rights reserved.

CPT only © 2006 American Medical Association (or such other date of publication of CPT). All Rights Reserved.

If you have a question regarding TRICARE benefits, please go to the TRICARE Contact Us page page.
If you need help with technical/operational issues, please go to the TRICARE Manuals Online Help page.

The appearance of hyperlinks to external websites does not constitute endorsement by the DHA of these websites or the information, products or services contained therein. For other than authorized government activities, the DHA does not exercise any editorial control over the information you may find at other locations. Such links are provided consistent with the stated purpose of this DoD website.


DHA Address: 7700 Arlington Boulevard | Suite 5101 | Falls Church, VA | 22042-5101

Some documents are presented in Portable Document Format (PDF). A PDF reader is required for viewing. Download a PDF Reader or learn more about PDFs.