Physicians as Assistants at Surgery: 2020 Update Participating Organizations: American College of Surgeons American Academy of Ophthalmology American Academy of Orthopaedic Surgeons American Academy of Otolaryngology – Head and Neck Surgery American Association of Neurological Surgeons American Pediatric Surgical Association American Society of Colon and Rectal Surgeons American Society of Plastic Surgeons American Society of Transplant Surgeons American Urological Association Congress of Neurological Surgeons Society for Surgical Oncology Society for Vascular Surgery Society of American Gastrointestinal Endoscopic Surgeons The American College of Obstetricians and Gynecologists The Society of Thoracic Surgeons Physicians as Assistants at Surgery: 2020 Update INTRODUCTION This is the ninth edition of Physicians as Assistants at Surgery, a study first undertaken in 1994 by the American College of Surgeons and other surgical specialty organizations The study reviews all procedures listed in the “Surgery” section of the 2020 American Medical Association’s Current Procedural Terminology (CPT TM) Each organization was asked to review new or revised codes since 2018 and determine whether the operation requires the use of a physician as an assistant at surgery: (1) almost always; (2) almost never; or (3) some of the time The results of this study are presented in the accompanying report, which is in a table format This table presents information about the need for a physician as an assistant at surgery Also, please note that an indication that a physician would “almost never” be needed to assist at surgery for some procedures does NOT imply that a physician is never needed The decision to request that a physician assist at surgery remains the responsibility of the primary surgeon and, when necessary, should be a payable service It should be noted that unlisted procedure codes are not included in this table because by nature they are undefined and vary on a case-by-case basis The organizations participating in this effort understand that local resources and patient characteristics can have an impact on the type of professional who may be asked to serve as an assistant at surgery In fact, the College often receives requests for an assessment of how and when non-physician providers may serve in this role and for what procedures This is an enormously complex issue that cannot be addressed by a single table of the sort included in this report However, the inclusion of any particular service on this table should not be interpreted to mean that a non-physician provider can never serve as an assistant at surgery in some circumstances, nor should the omission of a service on this list be interpreted to mean that assistance from non-physician providers is not needed An excerpt from the American College of Surgeons Statements on Principles has been included in this document in an effort to address the issue of non-physician assistants, at least in part The excerpt “Surgical Assistants” describes the College’s view on the qualifications of those who serve as first assistants in the operating room Questions concerning this study or requests for additional copies should be directed to the College as follows: American College of Surgeons 20 F Street, NW, Suite 1000 Washington, DC 20001 Tel 202/337-2701 Fax 202/337-4271 e-mail: regulatory@facs.org American College of Surgeons Statements on Principles II QUALIFICATIONS OF THE RESPONSIBLE SURGEON G Surgical Assistants The first assistant in a surgical operation should be a trained individual who is able to participate in and actively assist the surgeon in completing the operation safely and expeditiously by helping to provide exposure, maintain hemostasis, and serve other technical functions The qualifications of the person in this role may vary with the nature of the operation, the surgical specialty, and the type of hospital or ambulatory surgical facility The American College of Surgeons supports the concept that, ideally, the first assistant at the operating table should be a qualified surgeon or a resident in an approved surgical training program Residents who have appropriate levels of training should be provided with opportunities to assist and participate in operations If such assistants are unavailable, other physicians who are experienced in assisting may participate It may be necessary to have nonphysicians serve as first assistants Surgeon assistants (SAs) or physician assistants (PAs) with additional surgical training should meet national standards and be credentialed by the appropriate local authority These individuals are not authorized to operate independently Formal application for appointment to a hospital as a SA or PA should include the following qualifications and credentials: • Specification of which surgeon the applicant will assist and what duties that will be performed • Indication of which surgeon will be responsible for the supervision and performance of the SA or PA • Review and approval of the application by the hospital board • Registered nurses with specialized training may function as first assistants If such a situation should occur, the size of the operating room team should not be reduced; the nurse assistant should not simultaneously function as the scrub nurse and instrument nurse when serving as the first assistant Nurse assistant practice privileges should be granted based upon the hospital board's review and approval of credentials Registered nurses who act as first assistants must not have responsibility beyond the level defined in their state nursing practice act Surgeons are encouraged to participate in the training of allied health personnel Such individuals perform their duties under the supervision of the surgeon 2020 Assistant at Surgery Consensus1 CPT 10004 10005 10006 10007 10008 10009 10010 10021 10030 10035 10036 10040 10060 10061 10080 10081 10120 10121 10140 10160 10180 11000 11001 11004 11005 11006 11008 11010 2020 Descriptor Fine needle aspiration biopsy, without imaging guidance; each additional lesion (List separately in addition to code for primary procedure) Fine needle aspiration biopsy, including ultrasound guidance; first lesion Fine needle aspiration biopsy, including ultrasound guidance; each additional lesion (List separately in addition to code for primary procedure) Fine needle aspiration biopsy, including fluoroscopic guidance; first lesion Fine needle aspiration biopsy, including fluoroscopic guidance; each additional lesion (List separately in addition to code for primary procedure) Fine needle aspiration biopsy, including CT guidance; first lesion Fine needle aspiration biopsy, including CT guidance; each additional lesion (List separately in addition to code for primary procedure) Fine needle aspiration biopsy, without imaging guidance; first lesion Image-guided fluid collection drainage by catheter (eg, abscess, hematoma, seroma, lymphocele, cyst), soft tissue (eg, extremity, abdominal wall, neck), percutaneous Placement of soft tissue localization device(s) (eg, clip, metallic pellet, wire/needle, radioactive seeds), percutaneous, including imaging guidance; first lesion Placement of soft tissue localization device(s) (eg, clip, metallic pellet, wire/needle, radioactive seeds), percutaneous, including imaging guidance; each additional lesion (List separately in addition to code for primary procedure) Acne surgery (eg, marsupialization, opening or removal of multiple milia, comedones, cysts, pustules) Incision and drainage of abscess (eg, carbuncle, suppurative hidradenitis, cutaneous or subcutaneous abscess, cyst, furuncle, or paronychia); simple or single Incision and drainage of abscess (eg, carbuncle, suppurative hidradenitis, cutaneous or subcutaneous abscess, cyst, furuncle, or paronychia); complicated or multiple Incision and drainage of pilonidal cyst; simple Incision and drainage of pilonidal cyst; complicated Incision and removal of foreign body, subcutaneous tissues; simple Incision and removal of foreign body, subcutaneous tissues; complicated Incision and drainage of hematoma, seroma or fluid collection Puncture aspiration of abscess, hematoma, bulla, or cyst Incision and drainage, complex, postoperative wound infection Debridement of extensive eczematous or infected skin; up to 10% of body surface Debridement of extensive eczematous or infected skin; each additional 10% of the body surface, or part thereof (List separately in addition to code for primary procedure) Debridement of skin, subcutaneous tissue, muscle and fascia for necrotizing soft tissue infection; external genitalia and perineum Debridement of skin, subcutaneous tissue, muscle and fascia for necrotizing soft tissue infection; abdominal wall, with or without fascial closure Debridement of skin, subcutaneous tissue, muscle and fascia for necrotizing soft tissue infection; external genitalia, perineum and abdominal wall, with or without fascial closure Removal of prosthetic material or mesh, abdominal wall for infection (eg, for chronic or recurrent mesh infection or necrotizing soft tissue infection) (List separately in addition to code for primary procedure) Debridement including removal of foreign material at the site of an open fracture and/or an open dislocation (eg, excisional debridement); skin and subcutaneous tissues Almost Always Sometimes Almost Never X X X X X X X X X X X X X X X X X X X X X X X X X X X X This table presents information about the need for a physician as a first assistant at surgery (indicated with an "X") Please note that for some procedures, the services of a physician as a second assistant at surgery may be needed (indicated with an "O") The indication that a physician would almost never be needed to assist at surgery for some procedures does NOT imply that a physician is never needed The decision to request that a physician assist at surgery remains the responsibility of the primary surgeons and, when necessary, should be a payable service CPT codes and descriptors only are © 2019 American Medical Association October 2020 2020 Assistant at Surgery Consensus1 CPT 11011 11012 11042 11043 11044 11045 11046 11047 11055 11056 11057 11102 11103 11104 11105 11106 11107 11200 11201 11300 11301 11302 11303 2020 Descriptor Debridement including removal of foreign material at the site of an open fracture and/or an open dislocation (eg, excisional debridement); skin, subcutaneous tissue, muscle fascia, and muscle Debridement including removal of foreign material at the site of an open fracture and/or an open dislocation (eg, excisional debridement); skin, subcutaneous tissue, muscle fascia, muscle, and bone Debridement, subcutaneous tissue (includes epidermis and dermis, if performed); first 20 sq cm or less Debridement, muscle and/or fascia (includes epidermis, dermis, and subcutaneous tissue, if performed); first 20 sq cm or less Debridement, bone (includes epidermis, dermis, subcutaneous tissue, muscle and/or fascia, if performed); first 20 sq cm or less Debridement, subcutaneous tissue (includes epidermis and dermis, if performed); each additional 20 sq cm, or part thereof (List separately in addition to code for primary procedure) Debridement, muscle and/or fascia (includes epidermis, dermis, and subcutaneous tissue, if performed); each additional 20 sq cm, or part thereof (List separately in addition to code for primary procedure) Debridement, bone (includes epidermis, dermis, subcutaneous tissue, muscle and/or fascia, if performed); each additional 20 sq cm, or part thereof (List separately in addition to code for primary procedure) Paring or cutting of benign hyperkeratotic lesion (eg, corn or callus); single lesion Paring or cutting of benign hyperkeratotic lesion (eg, corn or callus); to lesions Paring or cutting of benign hyperkeratotic lesion (eg, corn or callus); more than lesions Tangential biopsy of skin (eg, shave, scoop, saucerize, curette); single lesion Tangential biopsy of skin (eg, shave, scoop, saucerize, curette); each separate/additional lesion (List separately in addition to code for primary procedure) Punch biopsy of skin (including simple closure, when performed); single lesion Punch biopsy of skin (including simple closure, when performed); each separate/additional lesion (List separately in addition to code for primary procedure) Incisional biopsy of skin (eg, wedge) (including simple closure, when performed); single lesion Incisional biopsy of skin (eg, wedge) (including simple closure, when performed); each separate/additional lesion (List separately in addition to code for primary procedure) Removal of skin tags, multiple fibrocutaneous tags, any area; up to and including 15 lesions Removal of skin tags, multiple fibrocutaneous tags, any area; each additional 10 lesions, or part thereof (List separately in addition to code for primary procedure) Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter over 2.0 cm Almost Always Sometimes Almost Never X X X X X X X X X X X X X X X X X X X X X X X This table presents information about the need for a physician as a first assistant at surgery (indicated with an "X") Please note that for some procedures, the services of a physician as a second assistant at surgery may be needed (indicated with an "O") The indication that a physician would almost never be needed to assist at surgery for some procedures does NOT imply that a physician is never needed The decision to request that a physician assist at surgery remains the responsibility of the primary surgeons and, when necessary, should be a payable service CPT codes and descriptors only are © 2019 American Medical Association October 2020 2020 Assistant at Surgery Consensus1 CPT 11305 11306 11307 11308 11310 11311 11312 11313 11400 11401 11402 11403 11404 11406 11420 11421 11422 11423 11424 11426 11440 11441 2020 Descriptor Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 2.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), trunk, arms or legs; excised diameter 0.5 cm or less Excision, benign lesion including margins, except skin tag (unless listed elsewhere), trunk, arms or legs; excised diameter 0.6 to 1.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), trunk, arms or legs; excised diameter 1.1 to 2.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), trunk, arms or legs; excised diameter 2.1 to 3.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), trunk, arms or legs; excised diameter 3.1 to 4.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), trunk, arms or legs; excised diameter over 4.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter 0.5 cm or less Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter 0.6 to 1.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter 1.1 to 2.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter 2.1 to 3.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter 3.1 to 4.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter over 4.0 cm Excision, other benign lesion including margins, except skin tag (unless listed elsewhere), face, ears, eyelids, nose, lips, mucous membrane; excised diameter 0.5 cm or less Excision, other benign lesion including margins, except skin tag (unless listed elsewhere), face, ears, eyelids, nose, lips, mucous membrane; excised diameter 0.6 to 1.0 cm Almost Always Sometimes Almost Never X X X X X X X X X X X X X X X X X X X X X X This table presents information about the need for a physician as a first assistant at surgery (indicated with an "X") Please note that for some procedures, the services of a physician as a second assistant at surgery may be needed (indicated with an "O") The indication that a physician would almost never be needed to assist at surgery for some procedures does NOT imply that a physician is never needed The decision to request that a physician assist at surgery remains the responsibility of the primary surgeons and, when necessary, should be a payable service CPT codes and descriptors only are © 2019 American Medical Association October 2020 2020 Assistant at Surgery Consensus1 CPT 11442 11443 11444 11446 11450 11451 11462 11463 11470 11471 11600 11601 11602 11603 11604 11606 11620 11621 11622 11623 11624 11626 11640 2020 Descriptor Excision, other benign lesion including margins, except skin tag (unless listed elsewhere), face, ears, eyelids, nose, lips, mucous membrane; excised diameter 1.1 to 2.0 cm Excision, other benign lesion including margins, except skin tag (unless listed elsewhere), face, ears, eyelids, nose, lips, mucous membrane; excised diameter 2.1 to 3.0 cm Excision, other benign lesion including margins, except skin tag (unless listed elsewhere), face, ears, eyelids, nose, lips, mucous membrane; excised diameter 3.1 to 4.0 cm Excision, other benign lesion including margins, except skin tag (unless listed elsewhere), face, ears, eyelids, nose, lips, mucous membrane; excised diameter over 4.0 cm Excision of skin and subcutaneous tissue for hidradenitis, axillary; with simple or intermediate repair Excision of skin and subcutaneous tissue for hidradenitis, axillary; with complex repair Excision of skin and subcutaneous tissue for hidradenitis, inguinal; with simple or intermediate repair Excision of skin and subcutaneous tissue for hidradenitis, inguinal; with complex repair Excision of skin and subcutaneous tissue for hidradenitis, perianal, perineal, or umbilical; with simple or intermediate repair Excision of skin and subcutaneous tissue for hidradenitis, perianal, perineal, or umbilical; with complex repair Excision, malignant lesion including margins, trunk, arms, or legs; excised diameter 0.5 cm or less Excision, malignant lesion including margins, trunk, arms, or legs; excised diameter 0.6 to 1.0 cm Excision, malignant lesion including margins, trunk, arms, or legs; excised diameter 1.1 to 2.0 cm Excision, malignant lesion including margins, trunk, arms, or legs; excised diameter 2.1 to 3.0 cm Excision, malignant lesion including margins, trunk, arms, or legs; excised diameter 3.1 to 4.0 cm Excision, malignant lesion including margins, trunk, arms, or legs; excised diameter over 4.0 cm Excision, malignant lesion including margins, scalp, neck, hands, feet, genitalia; excised diameter 0.5 cm or less Excision, malignant lesion including margins, scalp, neck, hands, feet, genitalia; excised diameter 0.6 to 1.0 cm Excision, malignant lesion including margins, scalp, neck, hands, feet, genitalia; excised diameter 1.1 to 2.0 cm Excision, malignant lesion including margins, scalp, neck, hands, feet, genitalia; excised diameter 2.1 to 3.0 cm Excision, malignant lesion including margins, scalp, neck, hands, feet, genitalia; excised diameter 3.1 to 4.0 cm Excision, malignant lesion including margins, scalp, neck, hands, feet, genitalia; excised diameter over 4.0 cm Excision, malignant lesion including margins, face, ears, eyelids, nose, lips; excised diameter 0.5 cm or less Almost Always Sometimes Almost Never X X X X X X X X X X X X X X X X X X X X X X X This table presents information about the need for a physician as a first assistant at surgery (indicated with an "X") Please note that for some procedures, the services of a physician as a second assistant at surgery may be needed (indicated with an "O") The indication that a physician would almost never be needed to assist at surgery for some procedures does NOT imply that a physician is never needed The decision to request that a physician assist at surgery remains the responsibility of the primary surgeons and, when necessary, should be a payable service CPT codes and descriptors only are © 2019 American Medical Association October 2020 2020 Assistant at Surgery Consensus1 CPT 11641 11642 11643 11644 11646 11719 11720 11721 11730 11732 11740 11750 11755 11760 11762 11765 11770 11771 11772 11900 11901 11920 11921 11922 11950 11951 11952 11954 11960 11970 11971 11976 11980 2020 Descriptor Excision, malignant lesion including margins, face, ears, eyelids, nose, lips; excised diameter 0.6 to 1.0 cm Excision, malignant lesion including margins, face, ears, eyelids, nose, lips; excised diameter 1.1 to 2.0 cm Excision, malignant lesion including margins, face, ears, eyelids, nose, lips; excised diameter 2.1 to 3.0 cm Excision, malignant lesion including margins, face, ears, eyelids, nose, lips; excised diameter 3.1 to 4.0 cm Excision, malignant lesion including margins, face, ears, eyelids, nose, lips; excised diameter over 4.0 cm Trimming of nondystrophic nails, any number Debridement of nail(s) by any method(s); to Debridement of nail(s) by any method(s); or more Avulsion of nail plate, partial or complete, simple; single Avulsion of nail plate, partial or complete, simple; each additional nail plate (List separately in addition to code for primary procedure) Evacuation of subungual hematoma Excision of nail and nail matrix, partial or complete (eg, ingrown or deformed nail), for permanent removal Biopsy of nail unit (eg, plate, bed, matrix, hyponychium, proximal and lateral nail folds) (separate procedure) Repair of nail bed Reconstruction of nail bed with graft Wedge excision of skin of nail fold (eg, for ingrown toenail) Excision of pilonidal cyst or sinus; simple Excision of pilonidal cyst or sinus; extensive Excision of pilonidal cyst or sinus; complicated Injection, intralesional; up to and including lesions Injection, intralesional; more than lesions Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; 6.0 sq cm or less Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; 6.1 to 20.0 sq cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; each additional 20.0 sq cm, or part thereof (List separately in addition to code for primary procedure) Subcutaneous injection of filling material (eg, collagen); cc or less Subcutaneous injection of filling material (eg, collagen); 1.1 to 5.0 cc Subcutaneous injection of filling material (eg, collagen); 5.1 to 10.0 cc Subcutaneous injection of filling material (eg, collagen); over 10.0 cc Insertion of tissue expander(s) for other than breast, including subsequent expansion Replacement of tissue expander with permanent prosthesis Removal of tissue expander(s) without insertion of prosthesis Removal, implantable contraceptive capsules Subcutaneous hormone pellet implantation (implantation of estradiol and/or testosterone pellets beneath the skin) Almost Always Sometimes Almost Never X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X This table presents information about the need for a physician as a first assistant at surgery (indicated with an "X") Please note that for some procedures, the services of a physician as a second assistant at surgery may be needed (indicated with an "O") The indication that a physician would almost never be needed to assist at surgery for some procedures does NOT imply that a physician is never needed The decision to request that a physician assist at surgery remains the responsibility of the primary surgeons and, when necessary, should be a payable service CPT codes and descriptors only are © 2019 American Medical Association October 2020 2020 Assistant at Surgery Consensus1 CPT 11981 11982 11983 12001 12002 12004 12005 12006 12007 12011 12013 12014 12015 12016 12017 12018 12020 12021 12031 12032 12034 12035 12036 12037 12041 12042 2020 Descriptor Insertion, non-biodegradable drug delivery implant Removal, non-biodegradable drug delivery implant Removal with reinsertion, non-biodegradable drug delivery implant Simple repair of superficial wounds of scalp, neck, axillae, external genitalia, trunk and/or extremities (including hands and feet); 2.5 cm or less Simple repair of superficial wounds of scalp, neck, axillae, external genitalia, trunk and/or extremities (including hands and feet); 2.6 cm to 7.5 cm Simple repair of superficial wounds of scalp, neck, axillae, external genitalia, trunk and/or extremities (including hands and feet); 7.6 cm to 12.5 cm Simple repair of superficial wounds of scalp, neck, axillae, external genitalia, trunk and/or extremities (including hands and feet); 12.6 cm to 20.0 cm Simple repair of superficial wounds of scalp, neck, axillae, external genitalia, trunk and/or extremities (including hands and feet); 20.1 cm to 30.0 cm Simple repair of superficial wounds of scalp, neck, axillae, external genitalia, trunk and/or extremities (including hands and feet); over 30.0 cm Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.5 cm or less Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.6 cm to 5.0 cm Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 5.1 cm to 7.5 cm Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 7.6 cm to 12.5 cm Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 12.6 cm to 20.0 cm Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 20.1 cm to 30.0 cm Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; over 30.0 cm Treatment of superficial wound dehiscence; simple closure Treatment of superficial wound dehiscence; with packing Repair, intermediate, wounds of scalp, axillae, trunk and/or extremities (excluding hands and feet); 2.5 cm or less Repair, intermediate, wounds of scalp, axillae, trunk and/or extremities (excluding hands and feet); 2.6 cm to 7.5 cm Repair, intermediate, wounds of scalp, axillae, trunk and/or extremities (excluding hands and feet); 7.6 cm to 12.5 cm Repair, intermediate, wounds of scalp, axillae, trunk and/or extremities (excluding hands and feet); 12.6 cm to 20.0 cm Repair, intermediate, wounds of scalp, axillae, trunk and/or extremities (excluding hands and feet); 20.1 cm to 30.0 cm Repair, intermediate, wounds of scalp, axillae, trunk and/or extremities (excluding hands and feet); over 30.0 cm Repair, intermediate, wounds of neck, hands, feet and/or external genitalia; 2.5 cm or less Repair, intermediate, wounds of neck, hands, feet and/or external genitalia; 2.6 cm to 7.5 cm Almost Always Sometimes Almost Never X X X X X X X X X X X X X X X X X X X X X X X X X X This table presents information about the need for a physician as a first assistant at surgery (indicated with an "X") Please note that for some procedures, the services of a physician as a second assistant at surgery may be needed (indicated with an "O") The indication that a physician would almost never be needed to assist at surgery for some procedures does NOT imply that a physician is never needed The decision to request that a physician assist at surgery remains the responsibility of the primary surgeons and, when necessary, should be a payable service CPT codes and descriptors only are © 2019 American Medical Association October 2020 2020 Assistant at Surgery Consensus1 CPT 12044 12045 12046 12047 12051 12052 12053 12054 12055 12056 12057 13100 13101 13102 13120 13121 13122 13131 13132 13133 13151 13152 13153 13160 14000 14001 14020 2020 Descriptor Repair, intermediate, wounds of neck, hands, feet and/or external genitalia; 7.6 cm to 12.5 cm Repair, intermediate, wounds of neck, hands, feet and/or external genitalia; 12.6 cm to 20.0 cm Repair, intermediate, wounds of neck, hands, feet and/or external genitalia; 20.1 cm to 30.0 cm Repair, intermediate, wounds of neck, hands, feet and/or external genitalia; over 30.0 cm Repair, intermediate, wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.5 cm or less Repair, intermediate, wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.6 cm to 5.0 cm Repair, intermediate, wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 5.1 cm to 7.5 cm Repair, intermediate, wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 7.6 cm to 12.5 cm Repair, intermediate, wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 12.6 cm to 20.0 cm Repair, intermediate, wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 20.1 cm to 30.0 cm Repair, intermediate, wounds of face, ears, eyelids, nose, lips and/or mucous membranes; over 30.0 cm Repair, complex, trunk; 1.1 cm to 2.5 cm Repair, complex, trunk; 2.6 cm to 7.5 cm Repair, complex, trunk; each additional cm or less (List separately in addition to code for primary procedure) Repair, complex, scalp, arms, and/or legs; 1.1 cm to 2.5 cm Repair, complex, scalp, arms, and/or legs; 2.6 cm to 7.5 cm Repair, complex, scalp, arms, and/or legs; each additional cm or less (List separately in addition to code for primary procedure) Repair, complex, forehead, cheeks, chin, mouth, neck, axillae, genitalia, hands and/or feet; 1.1 cm to 2.5 cm Repair, complex, forehead, cheeks, chin, mouth, neck, axillae, genitalia, hands and/or feet; 2.6 cm to 7.5 cm Repair, complex, forehead, cheeks, chin, mouth, neck, axillae, genitalia, hands and/or feet; each additional cm or less (List separately in addition to code for primary procedure) Repair, complex, eyelids, nose, ears and/or lips; 1.1 cm to 2.5 cm Repair, complex, eyelids, nose, ears and/or lips; 2.6 cm to 7.5 cm Repair, complex, eyelids, nose, ears and/or lips; each additional cm or less (List separately in addition to code for primary procedure) Secondary closure of surgical wound or dehiscence, extensive or complicated Adjacent tissue transfer or rearrangement, trunk; defect 10 sq cm or less Adjacent tissue transfer or rearrangement, trunk; defect 10.1 sq cm to 30.0 sq cm Adjacent tissue transfer or rearrangement, scalp, arms and/or legs; defect 10 sq cm or less Almost Always Sometimes Almost Never X X X X X X X X X X X X X X X X X X X X X X X X X X X This table presents information about the need for a physician as a first assistant at surgery (indicated with an "X") Please note that for some procedures, the services of a physician as a second assistant at surgery may be needed (indicated with an "O") The indication that a physician would almost never be needed to assist at surgery for some procedures does NOT imply that a physician is never needed The decision to request that a physician assist at surgery remains the responsibility of the primary surgeons and, when necessary, should be a payable service CPT codes and descriptors only are © 2019 American Medical Association October 2020 2020 Assistant at Surgery Consensus1 CPT 64645 64646 64647 64650 64653 64680 64681 64702 64704 64708 64712 64713 64714 64716 64718 64719 64721 64722 64726 64727 64732 64734 64736 64738 64740 64742 64744 64746 64755 64760 64763 64766 64771 64772 64774 64776 64778 2020 Descriptor Chemodenervation of one extremity; each additional extremity, or more muscles (List separately in addition to code for primary procedure) Chemodenervation of trunk muscle(s); 1-5 muscle(s) Chemodenervation of trunk muscle(s); or more muscles Chemodenervation of eccrine glands; both axillae Chemodenervation of eccrine glands; other area(s) (eg, scalp, face, neck), per day Destruction by neurolytic agent, with or without radiologic monitoring; celiac plexus Destruction by neurolytic agent, with or without radiologic monitoring; superior hypogastric plexus Neuroplasty; digital, or both, same digit Neuroplasty; nerve of hand or foot Neuroplasty, major peripheral nerve, arm or leg, open; other than specified Neuroplasty, major peripheral nerve, arm or leg, open; sciatic nerve Neuroplasty, major peripheral nerve, arm or leg, open; brachial plexus Neuroplasty, major peripheral nerve, arm or leg, open; lumbar plexus Neuroplasty and/or transposition; cranial nerve (specify) Neuroplasty and/or transposition; ulnar nerve at elbow Neuroplasty and/or transposition; ulnar nerve at wrist Neuroplasty and/or transposition; median nerve at carpal tunnel Decompression; unspecified nerve(s) (specify) Decompression; plantar digital nerve Internal neurolysis, requiring use of operating microscope (List separately in addition to code for neuroplasty) (Neuroplasty includes external neurolysis) Transection or avulsion of; supraorbital nerve Transection or avulsion of; infraorbital nerve Transection or avulsion of; mental nerve Transection or avulsion of; inferior alveolar nerve by osteotomy Transection or avulsion of; lingual nerve Transection or avulsion of; facial nerve, differential or complete Transection or avulsion of; greater occipital nerve Transection or avulsion of; phrenic nerve Transection or avulsion of; vagus nerves limited to proximal stomach (selective proximal vagotomy, proximal gastric vagotomy, parietal cell vagotomy, supra- or highly selective vagotomy) Transection or avulsion of; vagus nerve (vagotomy), abdominal Transection or avulsion of obturator nerve, extrapelvic, with or without adductor tenotomy Transection or avulsion of obturator nerve, intrapelvic, with or without adductor tenotomy Transection or avulsion of other cranial nerve, extradural Transection or avulsion of other spinal nerve, extradural Excision of neuroma; cutaneous nerve, surgically identifiable Excision of neuroma; digital nerve, or both, same digit Excision of neuroma; digital nerve, each additional digit (List separately in addition to code for primary procedure) Almost Always Sometimes Almost Never X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X This table presents information about the need for a physician as a first assistant at surgery (indicated with an "X") Please note that for some procedures, the services of a physician as a second assistant at surgery may be needed (indicated with an "O") The indication that a physician would almost never be needed to assist at surgery for some procedures does NOT imply that a physician is never needed The decision to request that a physician assist at surgery remains the responsibility of the primary surgeons and, when necessary, should be a payable service CPT codes and descriptors only are © 2019 American Medical Association October 2020 189 2020 Assistant at Surgery Consensus1 CPT 64782 64783 64784 64786 64787 64788 64790 64792 64795 64802 64804 64809 64818 64820 64821 64822 64823 64831 64832 64834 64835 64836 64837 64840 64856 64857 64858 64859 64861 64862 64864 64865 64866 64868 64872 64874 64876 2020 Descriptor Excision of neuroma; hand or foot, except digital nerve Excision of neuroma; hand or foot, each additional nerve, except same digit (List separately in addition to code for primary procedure) Excision of neuroma; major peripheral nerve, except sciatic Excision of neuroma; sciatic nerve Implantation of nerve end into bone or muscle (List separately in addition to neuroma excision) Excision of neurofibroma or neurolemmoma; cutaneous nerve Excision of neurofibroma or neurolemmoma; major peripheral nerve Excision of neurofibroma or neurolemmoma; extensive (including malignant type) Biopsy of nerve Sympathectomy, cervical Sympathectomy, cervicothoracic Sympathectomy, thoracolumbar Sympathectomy, lumbar Sympathectomy; digital arteries, each digit Sympathectomy; radial artery Sympathectomy; ulnar artery Sympathectomy; superficial palmar arch Suture of digital nerve, hand or foot; nerve Suture of digital nerve, hand or foot; each additional digital nerve (List separately in addition to code for primary procedure) Suture of nerve; hand or foot, common sensory nerve Suture of nerve; median motor thenar Suture of nerve; ulnar motor Suture of each additional nerve, hand or foot (List separately in addition to code for primary procedure) Suture of posterior tibial nerve Suture of major peripheral nerve, arm or leg, except sciatic; including transposition Suture of major peripheral nerve, arm or leg, except sciatic; without transposition Suture of sciatic nerve Suture of each additional major peripheral nerve (List separately in addition to code for primary procedure) Suture of; brachial plexus Suture of; lumbar plexus Suture of facial nerve; extracranial Suture of facial nerve; infratemporal, with or without grafting Anastomosis; facial-spinal accessory Anastomosis; facial-hypoglossal Suture of nerve; requiring secondary or delayed suture (List separately in addition to code for primary neurorrhaphy) Suture of nerve; requiring extensive mobilization, or transposition of nerve (List separately in addition to code for nerve suture) Suture of nerve; requiring shortening of bone of extremity (List separately in addition to code for nerve suture) Almost Always Sometimes Almost Never X X X X X X X X X X X X X O X X X X X X X X X X X X X X X X X X X X X X X X This table presents information about the need for a physician as a first assistant at surgery (indicated with an "X") Please note that for some procedures, the services of a physician as a second assistant at surgery may be needed (indicated with an "O") The indication that a physician would almost never be needed to assist at surgery for some procedures does NOT imply that a physician is never needed The decision to request that a physician assist at surgery remains the responsibility of the primary surgeons and, when necessary, should be a payable service CPT codes and descriptors only are © 2019 American Medical Association October 2020 190 2020 Assistant at Surgery Consensus1 CPT 2020 Descriptor 64885 64886 64890 64891 64892 64893 Nerve graft (includes obtaining graft), head or neck; up to cm in length Nerve graft (includes obtaining graft), head or neck; more than cm length Nerve graft (includes obtaining graft), single strand, hand or foot; up to cm length Nerve graft (includes obtaining graft), single strand, hand or foot; more than cm length Nerve graft (includes obtaining graft), single strand, arm or leg; up to cm length Nerve graft (includes obtaining graft), single strand, arm or leg; more than cm length Nerve graft (includes obtaining graft), multiple strands (cable), hand or foot; up to cm length Nerve graft (includes obtaining graft), multiple strands (cable), hand or foot; more than cm length Nerve graft (includes obtaining graft), multiple strands (cable), arm or leg; up to cm length Nerve graft (includes obtaining graft), multiple strands (cable), arm or leg; more than cm length Nerve graft, each additional nerve; single strand (List separately in addition to code for primary procedure) Nerve graft, each additional nerve; multiple strands (cable) (List separately in addition to code for primary procedure) Nerve pedicle transfer; first stage Nerve pedicle transfer; second stage Nerve repair; with synthetic conduit or vein allograft (eg, nerve tube), each nerve Nerve repair; with autogenous vein graft (includes harvest of vein graft), each nerve Nerve repair; with nerve allograft, each nerve, first strand (cable) Nerve repair; with nerve allograft, each additional strand (List separately in addition to code for primary procedure) Evisceration of ocular contents; without implant Evisceration of ocular contents; with implant Enucleation of eye; without implant Enucleation of eye; with implant, muscles not attached to implant Enucleation of eye; with implant, muscles attached to implant Exenteration of orbit (does not include skin graft), removal of orbital contents; only Exenteration of orbit (does not include skin graft), removal of orbital contents; with therapeutic removal of bone Exenteration of orbit (does not include skin graft), removal of orbital contents; with muscle or myocutaneous flap Modification of ocular implant with placement or replacement of pegs (eg, drilling receptacle for prosthesis appendage) (separate procedure) Insertion of ocular implant secondary; after evisceration, in scleral shell Insertion of ocular implant secondary; after enucleation, muscles not attached to implant Insertion of ocular implant secondary; after enucleation, muscles attached to implant Reinsertion of ocular implant; with or without conjunctival graft Reinsertion of ocular implant; with use of foreign material for reinforcement and/or attachment of muscles to implant Removal of ocular implant Removal of foreign body, external eye; conjunctival superficial 64895 64896 64897 64898 64901 64902 64905 64907 64910 64911 64912 64913 65091 65093 65101 65103 65105 65110 65112 65114 65125 65130 65135 65140 65150 65155 65175 65205 Almost Always Sometimes Almost Never X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X This table presents information about the need for a physician as a first assistant at surgery (indicated with an "X") Please note that for some procedures, the services of a physician as a second assistant at surgery may be needed (indicated with an "O") The indication that a physician would almost never be needed to assist at surgery for some procedures does NOT imply that a physician is never needed The decision to request that a physician assist at surgery remains the responsibility of the primary surgeons and, when necessary, should be a payable service CPT codes and descriptors only are © 2019 American Medical Association October 2020 191 2020 Assistant at Surgery Consensus1 CPT 65210 65220 65222 65235 65260 65265 65270 65272 65273 65275 65280 65285 65286 65290 65400 65410 65420 65426 65430 65435 65436 65450 65600 65710 65730 65750 65755 65756 65757 65760 65765 65767 65770 65771 65772 65775 65778 65779 2020 Descriptor Removal of foreign body, external eye; conjunctival embedded (includes concretions), subconjunctival, or scleral nonperforating Removal of foreign body, external eye; corneal, without slit lamp Removal of foreign body, external eye; corneal, with slit lamp Removal of foreign body, intraocular; from anterior chamber of eye or lens Removal of foreign body, intraocular; from posterior segment, magnetic extraction, anterior or posterior route Removal of foreign body, intraocular; from posterior segment, nonmagnetic extraction Repair of laceration; conjunctiva, with or without nonperforating laceration sclera, direct closure Repair of laceration; conjunctiva, by mobilization and rearrangement, without hospitalization Repair of laceration; conjunctiva, by mobilization and rearrangement, with hospitalization Repair of laceration; cornea, nonperforating, with or without removal foreign body Repair of laceration; cornea and/or sclera, perforating, not involving uveal tissue Repair of laceration; cornea and/or sclera, perforating, with reposition or resection of uveal tissue Repair of laceration; application of tissue glue, wounds of cornea and/or sclera Repair of wound, extraocular muscle, tendon and/or Tenon's capsule Excision of lesion, cornea (keratectomy, lamellar, partial), except pterygium Biopsy of cornea Excision or transposition of pterygium; without graft Excision or transposition of pterygium; with graft Scraping of cornea, diagnostic, for smear and/or culture Removal of corneal epithelium; with or without chemocauterization (abrasion, curettage) Removal of corneal epithelium; with application of chelating agent (eg, EDTA) Destruction of lesion of cornea by cryotherapy, photocoagulation or thermocauterization Multiple punctures of anterior cornea (eg, for corneal erosion, tattoo) Keratoplasty (corneal transplant); anterior lamellar Keratoplasty (corneal transplant); penetrating (except in aphakia or pseudophakia) Keratoplasty (corneal transplant); penetrating (in aphakia) Keratoplasty (corneal transplant); penetrating (in pseudophakia) Keratoplasty (corneal transplant); endothelial Backbench preparation of corneal endothelial allograft prior to transplantation (List separately in addition to code for primary procedure) Keratomileusis Keratophakia Epikeratoplasty Keratoprosthesis Radial keratotomy Corneal relaxing incision for correction of surgically induced astigmatism Corneal wedge resection for correction of surgically induced astigmatism Placement of amniotic membrane on the ocular surface; without sutures Placement of amniotic membrane on the ocular surface; single layer, sutured Almost Always Sometimes Almost Never X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X This table presents information about the need for a physician as a first assistant at surgery (indicated with an "X") Please note that for some procedures, the services of a physician as a second assistant at surgery may be needed (indicated with an "O") The indication that a physician would almost never be needed to assist at surgery for some procedures does NOT imply that a physician is never needed The decision to request that a physician assist at surgery remains the responsibility of the primary surgeons and, when necessary, should be a payable service CPT codes and descriptors only are © 2019 American Medical Association October 2020 192 2020 Assistant at Surgery Consensus1 CPT 2020 Descriptor 65780 65781 65782 65785 65800 Ocular surface reconstruction; amniotic membrane transplantation, multiple layers Ocular surface reconstruction; limbal stem cell allograft (eg, cadaveric or living donor) Ocular surface reconstruction; limbal conjunctival autograft (includes obtaining graft) Implantation of intrastromal corneal ring segments Paracentesis of anterior chamber of eye (separate procedure); with removal of aqueous Paracentesis of anterior chamber of eye (separate procedure); with removal of vitreous and/or discission of anterior hyaloid membrane, with or without air injection Paracentesis of anterior chamber of eye (separate procedure); with removal of blood, with or without irrigation and/or air injection Goniotomy Trabeculotomy ab externo Trabeculoplasty by laser surgery Severing adhesions of anterior segment, laser technique (separate procedure) Severing adhesions of anterior segment of eye, incisional technique (with or without injection of air or liquid) (separate procedure); goniosynechiae Severing adhesions of anterior segment of eye, incisional technique (with or without injection of air or liquid) (separate procedure); anterior synechiae, except goniosynechiae Severing adhesions of anterior segment of eye, incisional technique (with or without injection of air or liquid) (separate procedure); posterior synechiae Severing adhesions of anterior segment of eye, incisional technique (with or without injection of air or liquid) (separate procedure); corneovitreal adhesions Removal of epithelial downgrowth, anterior chamber of eye Removal of implanted material, anterior segment of eye Removal of blood clot, anterior segment of eye Injection, anterior chamber of eye (separate procedure); air or liquid Injection, anterior chamber of eye (separate procedure); medication Excision of lesion, sclera Fistulization of sclera for glaucoma; trephination with iridectomy Fistulization of sclera for glaucoma; thermocauterization with iridectomy Fistulization of sclera for glaucoma; sclerectomy with punch or scissors, with iridectomy Fistulization of sclera for glaucoma; trabeculectomy ab externo in absence of previous surgery Fistulization of sclera for glaucoma; trabeculectomy ab externo with scarring from previous ocular surgery or trauma (includes injection of antifibrotic agents) Transluminal dilation of aqueous outflow canal; without retention of device or stent Transluminal dilation of aqueous outflow canal; with retention of device or stent Aqueous shunt to extraocular equatorial plate reservoir, external approach; without graft Aqueous shunt to extraocular equatorial plate reservoir, external approach; with graft Insertion of anterior segment aqueous drainage device, without extraocular reservoir, external approach Revision of aqueous shunt to extraocular equatorial plate reservoir; without graft Revision of aqueous shunt to extraocular equatorial plate reservoir; with graft Repair of scleral staphyloma; with graft Revision or repair of operative wound of anterior segment, any type, early or late, major or minor procedure 65810 65815 65820 65850 65855 65860 65865 65870 65875 65880 65900 65920 65930 66020 66030 66130 66150 66155 66160 66170 66172 66174 66175 66179 66180 66183 66184 66185 66225 66250 Almost Always Sometimes Almost Never X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X This table presents information about the need for a physician as a first assistant at surgery (indicated with an "X") Please note that for some procedures, the services of a physician as a second assistant at surgery may be needed (indicated with an "O") The indication that a physician would almost never be needed to assist at surgery for some procedures does NOT imply that a physician is never needed The decision to request that a physician assist at surgery remains the responsibility of the primary surgeons and, when necessary, should be a payable service CPT codes and descriptors only are © 2019 American Medical Association October 2020 193 2020 Assistant at Surgery Consensus1 CPT 2020 Descriptor 66500 66505 66600 66605 Iridotomy by stab incision (separate procedure); except transfixion Iridotomy by stab incision (separate procedure); with transfixion as for iris bombe Iridectomy, with corneoscleral or corneal section; for removal of lesion Iridectomy, with corneoscleral or corneal section; with cyclectomy Iridectomy, with corneoscleral or corneal section; peripheral for glaucoma (separate procedure) Iridectomy, with corneoscleral or corneal section; sector for glaucoma (separate procedure) Iridectomy, with corneoscleral or corneal section; optical (separate procedure) Repair of iris, ciliary body (as for iridodialysis) Suture of iris, ciliary body (separate procedure) with retrieval of suture through small incision (eg, McCannel suture) Ciliary body destruction; diathermy Ciliary body destruction; cyclophotocoagulation, transscleral Ciliary body destruction; cyclophotocoagulation, endoscopic Ciliary body destruction; cryotherapy Ciliary body destruction; cyclodialysis Iridotomy/iridectomy by laser surgery (eg, for glaucoma) (per session) Iridoplasty by photocoagulation (1 or more sessions) (eg, for improvement of vision, for widening of anterior chamber angle) Destruction of cyst or lesion iris or ciliary body (nonexcisional procedure) Discission of secondary membranous cataract (opacified posterior lens capsule and/or anterior hyaloid); stab incision technique (Ziegler or Wheeler knife) Discission of secondary membranous cataract (opacified posterior lens capsule and/or anterior hyaloid); laser surgery (eg, YAG laser) (1 or more stages) Repositioning of intraocular lens prosthesis, requiring an incision (separate procedure) Removal of secondary membranous cataract (opacified posterior lens capsule and/or anterior hyaloid) with corneo-scleral section, with or without iridectomy (iridocapsulotomy, iridocapsulectomy) Removal of lens material; aspiration technique, or more stages Removal of lens material; phacofragmentation technique (mechanical or ultrasonic) (eg, phacoemulsification), with aspiration Removal of lens material; pars plana approach, with or without vitrectomy Removal of lens material; intracapsular Removal of lens material; intracapsular, for dislocated lens Removal of lens material; extracapsular (other than 66840, 66850, 66852) Extracapsular cataract removal with insertion of intraocular lens prosthesis (1-stage procedure), manual or mechanical technique (eg, irrigation and aspiration or phacoemulsification), complex, requiring devices or techniques not generally used in routine cataract surgery (eg, iris expansion device, suture support for intraocular lens, or primary posterior capsulorrhexis) or performed on patients in the amblyogenic developmental stage; without endoscopic cyclophotocoagulation Intracapsular cataract extraction with insertion of intraocular lens prosthesis (1 stage procedure) Extracapsular cataract removal with insertion of intraocular lens prosthesis (1 stage procedure), manual or mechanical technique (eg, irrigation and aspiration or phacoemulsification); without endoscopic cyclophotocoagulation 66625 66630 66635 66680 66682 66700 66710 66711 66720 66740 66761 66762 66770 66820 66821 66825 66830 66840 66850 66852 66920 66930 66940 66982 66983 66984 Almost Always Sometimes Almost Never X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X This table presents information about the need for a physician as a first assistant at surgery (indicated with an "X") Please note that for some procedures, the services of a physician as a second assistant at surgery may be needed (indicated with an "O") The indication that a physician would almost never be needed to assist at surgery for some procedures does NOT imply that a physician is never needed The decision to request that a physician assist at surgery remains the responsibility of the primary surgeons and, when necessary, should be a payable service CPT codes and descriptors only are © 2019 American Medical Association October 2020 194 2020 Assistant at Surgery Consensus1 CPT 66985 66986 66987 66988 66990 67005 67010 67015 67025 67027 67028 67030 67031 67036 67039 67040 67041 67042 67043 67101 67105 67107 2020 Descriptor Insertion of intraocular lens prosthesis (secondary implant), not associated with concurrent cataract removal Exchange of intraocular lens Extracapsular cataract removal with insertion of intraocular lens prosthesis (1-stage procedure), manual or mechanical technique (eg, irrigation and aspiration or phacoemulsification), complex, requiring devices or techniques not generally used in routine cataract surgery (eg, iris expansion device, suture support for intraocular lens, or primary posterior capsulorrhexis) or performed on patients in the amblyogenic developmental stage; with endoscopic cyclophotocoagulation Extracapsular cataract removal with insertion of intraocular lens prosthesis (1 stage procedure), manual or mechanical technique (eg, irrigation and aspiration or phacoemulsification); with endoscopic cyclophotocoagulation Use of ophthalmic endoscope (List separately in addition to code for primary procedure) Removal of vitreous, anterior approach (open sky technique or limbal incision); partial removal Removal of vitreous, anterior approach (open sky technique or limbal incision); subtotal removal with mechanical vitrectomy Aspiration or release of vitreous, subretinal or choroidal fluid, pars plana approach (posterior sclerotomy) Injection of vitreous substitute, pars plana or limbal approach (fluid-gas exchange), with or without aspiration (separate procedure) Implantation of intravitreal drug delivery system (eg, ganciclovir implant), includes concomitant removal of vitreous Intravitreal injection of a pharmacologic agent (separate procedure) Discission of vitreous strands (without removal), pars plana approach Severing of vitreous strands, vitreous face adhesions, sheets, membranes or opacities, laser surgery (1 or more stages) Vitrectomy, mechanical, pars plana approach; Vitrectomy, mechanical, pars plana approach; with focal endolaser photocoagulation Vitrectomy, mechanical, pars plana approach; with endolaser panretinal photocoagulation Vitrectomy, mechanical, pars plana approach; with removal of preretinal cellular membrane (eg, macular pucker) Vitrectomy, mechanical, pars plana approach; with removal of internal limiting membrane of retina (eg, for repair of macular hole, diabetic macular edema), includes, if performed, intraocular tamponade (ie, air, gas or silicone oil) Vitrectomy, mechanical, pars plana approach; with removal of subretinal membrane (eg, choroidal neovascularization), includes, if performed, intraocular tamponade (ie, air, gas or silicone oil) and laser photocoagulation Repair of retinal detachment, including drainage of subretinal fluid when performed; cryotherapy Repair of retinal detachment, including drainage of subretinal fluid when performed; photocoagulation Repair of retinal detachment; scleral buckling (such as lamellar scleral dissection, imbrication or encircling procedure), including, when performed, implant, cryotherapy, photocoagulation, and drainage of subretinal fluid Almost Always Sometimes Almost Never X X X X X X X X X X X X X X X X X X X X X X This table presents information about the need for a physician as a first assistant at surgery (indicated with an "X") Please note that for some procedures, the services of a physician as a second assistant at surgery may be needed (indicated with an "O") The indication that a physician would almost never be needed to assist at surgery for some procedures does NOT imply that a physician is never needed The decision to request that a physician assist at surgery remains the responsibility of the primary surgeons and, when necessary, should be a payable service CPT codes and descriptors only are © 2019 American Medical Association October 2020 195 2020 Assistant at Surgery Consensus1 CPT 67108 67110 67113 67115 67120 67121 67141 67145 67208 67210 67218 67220 67221 67225 67227 67228 67229 67250 67255 67311 67312 67314 67316 67318 67320 2020 Descriptor Repair of retinal detachment; with vitrectomy, any method, including, when performed, air or gas tamponade, focal endolaser photocoagulation, cryotherapy, drainage of subretinal fluid, scleral buckling, and/or removal of lens by same technique Repair of retinal detachment; by injection of air or other gas (eg, pneumatic retinopexy) Repair of complex retinal detachment (eg, proliferative vitreoretinopathy, stage C-1 or greater, diabetic traction retinal detachment, retinopathy of prematurity, retinal tear of greater than 90 degrees), with vitrectomy and membrane peeling, including, when performed, air, gas, or silicone oil tamponade, cryotherapy, endolaser photocoagulation, drainage of subretinal fluid, scleral buckling, and/or removal of lens Release of encircling material (posterior segment) Removal of implanted material, posterior segment; extraocular Removal of implanted material, posterior segment; intraocular Prophylaxis of retinal detachment (eg, retinal break, lattice degeneration) without drainage, or more sessions; cryotherapy, diathermy Prophylaxis of retinal detachment (eg, retinal break, lattice degeneration) without drainage, or more sessions; photocoagulation (laser or xenon arc) Destruction of localized lesion of retina (eg, macular edema, tumors), or more sessions; cryotherapy, diathermy Destruction of localized lesion of retina (eg, macular edema, tumors), or more sessions; photocoagulation Destruction of localized lesion of retina (eg, macular edema, tumors), or more sessions; radiation by implantation of source (includes removal of source) Destruction of localized lesion of choroid (eg, choroidal neovascularization); photocoagulation (eg, laser), or more sessions Destruction of localized lesion of choroid (eg, choroidal neovascularization); photodynamic therapy (includes intravenous infusion) Destruction of localized lesion of choroid (eg, choroidal neovascularization); photodynamic therapy, second eye, at single session (List separately in addition to code for primary eye treatment) Destruction of extensive or progressive retinopathy (eg, diabetic retinopathy), cryotherapy, diathermy Treatment of extensive or progressive retinopathy (eg, diabetic retinopathy), photocoagulation Treatment of extensive or progressive retinopathy, or more sessions, preterm infant (less than 37 weeks gestation at birth), performed from birth up to year of age (eg, retinopathy of prematurity), photocoagulation or cryotherapy Scleral reinforcement (separate procedure); without graft Scleral reinforcement (separate procedure); with graft Strabismus surgery, recession or resection procedure; horizontal muscle Strabismus surgery, recession or resection procedure; horizontal muscles Strabismus surgery, recession or resection procedure; vertical muscle (excluding superior oblique) Strabismus surgery, recession or resection procedure; or more vertical muscles (excluding superior oblique) Strabismus surgery, any procedure, superior oblique muscle Transposition procedure (eg, for paretic extraocular muscle), any extraocular muscle (specify) (List separately in addition to code for primary procedure) Almost Always Sometimes Almost Never X X X X X X X X X X X X X X X X X X X X X X X X X This table presents information about the need for a physician as a first assistant at surgery (indicated with an "X") Please note that for some procedures, the services of a physician as a second assistant at surgery may be needed (indicated with an "O") The indication that a physician would almost never be needed to assist at surgery for some procedures does NOT imply that a physician is never needed The decision to request that a physician assist at surgery remains the responsibility of the primary surgeons and, when necessary, should be a payable service CPT codes and descriptors only are © 2019 American Medical Association October 2020 196 2020 Assistant at Surgery Consensus1 CPT 67331 67332 67334 67335 67340 67343 67345 67346 67400 67405 67412 67413 67414 67415 67420 67430 67440 67445 67450 67500 67505 67515 67550 67560 67570 67700 67710 67715 67800 67801 2020 Descriptor Strabismus surgery on patient with previous eye surgery or injury that did not involve the extraocular muscles (List separately in addition to code for primary procedure) Strabismus surgery on patient with scarring of extraocular muscles (eg, prior ocular injury, strabismus or retinal detachment surgery) or restrictive myopathy (eg, dysthyroid ophthalmopathy) (List separately in addition to code for primary procedure) Strabismus surgery by posterior fixation suture technique, with or without muscle recession (List separately in addition to code for primary procedure) Placement of adjustable suture(s) during strabismus surgery, including postoperative adjustment(s) of suture(s) (List separately in addition to code for specific strabismus surgery) Strabismus surgery involving exploration and/or repair of detached extraocular muscle(s) (List separately in addition to code for primary procedure) Release of extensive scar tissue without detaching extraocular muscle (separate procedure) Chemodenervation of extraocular muscle Biopsy of extraocular muscle Orbitotomy without bone flap (frontal or transconjunctival approach); for exploration, with or without biopsy Orbitotomy without bone flap (frontal or transconjunctival approach); with drainage only Orbitotomy without bone flap (frontal or transconjunctival approach); with removal of lesion Orbitotomy without bone flap (frontal or transconjunctival approach); with removal of foreign body Orbitotomy without bone flap (frontal or transconjunctival approach); with removal of bone for decompression Fine needle aspiration of orbital contents Orbitotomy with bone flap or window, lateral approach (eg, Kroenlein); with removal of lesion Orbitotomy with bone flap or window, lateral approach (eg, Kroenlein); with removal of foreign body Orbitotomy with bone flap or window, lateral approach (eg, Kroenlein); with drainage Orbitotomy with bone flap or window, lateral approach (eg, Kroenlein); with removal of bone for decompression Orbitotomy with bone flap or window, lateral approach (eg, Kroenlein); for exploration, with or without biopsy Retrobulbar injection; medication (separate procedure, does not include supply of medication) Retrobulbar injection; alcohol Injection of medication or other substance into Tenon's capsule Orbital implant (implant outside muscle cone); insertion Orbital implant (implant outside muscle cone); removal or revision Optic nerve decompression (eg, incision or fenestration of optic nerve sheath) Blepharotomy, drainage of abscess, eyelid Severing of tarsorrhaphy Canthotomy (separate procedure) Excision of chalazion; single Excision of chalazion; multiple, same lid Almost Always Sometimes Almost Never X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X This table presents information about the need for a physician as a first assistant at surgery (indicated with an "X") Please note that for some procedures, the services of a physician as a second assistant at surgery may be needed (indicated with an "O") The indication that a physician would almost never be needed to assist at surgery for some procedures does NOT imply that a physician is never needed The decision to request that a physician assist at surgery remains the responsibility of the primary surgeons and, when necessary, should be a payable service CPT codes and descriptors only are © 2019 American Medical Association October 2020 197 2020 Assistant at Surgery Consensus1 CPT 2020 Descriptor 67805 Excision of chalazion; multiple, different lids Excision of chalazion; under general anesthesia and/or requiring hospitalization, single or multiple Incisional biopsy of eyelid skin including lid margin Correction of trichiasis; epilation, by forceps only Correction of trichiasis; epilation by other than forceps (eg, by electrosurgery, cryotherapy, laser surgery) Correction of trichiasis; incision of lid margin Correction of trichiasis; incision of lid margin, with free mucous membrane graft Excision of lesion of eyelid (except chalazion) without closure or with simple direct closure Destruction of lesion of lid margin (up to cm) Temporary closure of eyelids by suture (eg, Frost suture) Construction of intermarginal adhesions, median tarsorrhaphy, or canthorrhaphy; Construction of intermarginal adhesions, median tarsorrhaphy, or canthorrhaphy; with transposition of tarsal plate Repair of brow ptosis (supraciliary, mid-forehead or coronal approach) Repair of blepharoptosis; frontalis muscle technique with suture or other material (eg, banked fascia) Repair of blepharoptosis; frontalis muscle technique with autologous fascial sling (includes obtaining fascia) Repair of blepharoptosis; (tarso) levator resection or advancement, internal approach Repair of blepharoptosis; (tarso) levator resection or advancement, external approach Repair of blepharoptosis; superior rectus technique with fascial sling (includes obtaining fascia) Repair of blepharoptosis; conjunctivo-tarso-Muller's muscle-levator resection (eg, Fasanella-Servat type) Reduction of overcorrection of ptosis Correction of lid retraction Correction of lagophthalmos, with implantation of upper eyelid lid load (eg, gold weight) Repair of ectropion; suture Repair of ectropion; thermocauterization Repair of ectropion; excision tarsal wedge Repair of ectropion; extensive (eg, tarsal strip operations) Repair of entropion; suture Repair of entropion; thermocauterization Repair of entropion; excision tarsal wedge Repair of entropion; extensive (eg, tarsal strip or capsulopalpebral fascia repairs operation) Suture of recent wound, eyelid, involving lid margin, tarsus, and/or palpebral conjunctiva direct closure; partial thickness Suture of recent wound, eyelid, involving lid margin, tarsus, and/or palpebral conjunctiva direct closure; full thickness Removal of embedded foreign body, eyelid Canthoplasty (reconstruction of canthus) 67808 67810 67820 67825 67830 67835 67840 67850 67875 67880 67882 67900 67901 67902 67903 67904 67906 67908 67909 67911 67912 67914 67915 67916 67917 67921 67922 67923 67924 67930 67935 67938 67950 Almost Always Sometimes Almost Never X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X This table presents information about the need for a physician as a first assistant at surgery (indicated with an "X") Please note that for some procedures, the services of a physician as a second assistant at surgery may be needed (indicated with an "O") The indication that a physician would almost never be needed to assist at surgery for some procedures does NOT imply that a physician is never needed The decision to request that a physician assist at surgery remains the responsibility of the primary surgeons and, when necessary, should be a payable service CPT codes and descriptors only are © 2019 American Medical Association October 2020 198 2020 Assistant at Surgery Consensus1 CPT 67961 67966 67971 67973 67974 67975 68020 68040 68100 68110 68115 68130 68135 68200 68320 68325 68326 68328 68330 68335 68340 68360 68362 68371 68400 68420 68440 68500 68505 68510 68520 68525 68530 68540 2020 Descriptor Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; up to one-fourth of lid margin Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; over one-fourth of lid margin Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; up to two-thirds of eyelid, stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, lower, stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, upper, stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; second stage Incision of conjunctiva, drainage of cyst Expression of conjunctival follicles (eg, for trachoma) Biopsy of conjunctiva Excision of lesion, conjunctiva; up to cm Excision of lesion, conjunctiva; over cm Excision of lesion, conjunctiva; with adjacent sclera Destruction of lesion, conjunctiva Subconjunctival injection Conjunctivoplasty; with conjunctival graft or extensive rearrangement Conjunctivoplasty; with buccal mucous membrane graft (includes obtaining graft) Conjunctivoplasty, reconstruction cul-de-sac; with conjunctival graft or extensive rearrangement Conjunctivoplasty, reconstruction cul-de-sac; with buccal mucous membrane graft (includes obtaining graft) Repair of symblepharon; conjunctivoplasty, without graft Repair of symblepharon; with free graft conjunctiva or buccal mucous membrane (includes obtaining graft) Repair of symblepharon; division of symblepharon, with or without insertion of conformer or contact lens Conjunctival flap; bridge or partial (separate procedure) Conjunctival flap; total (such as Gunderson thin flap or purse string flap) Harvesting conjunctival allograft, living donor Incision, drainage of lacrimal gland Incision, drainage of lacrimal sac (dacryocystotomy or dacryocystostomy) Snip incision of lacrimal punctum Excision of lacrimal gland (dacryoadenectomy), except for tumor; total Excision of lacrimal gland (dacryoadenectomy), except for tumor; partial Biopsy of lacrimal gland Excision of lacrimal sac (dacryocystectomy) Biopsy of lacrimal sac Removal of foreign body or dacryolith, lacrimal passages Excision of lacrimal gland tumor; frontal approach Almost Always Sometimes Almost Never X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X This table presents information about the need for a physician as a first assistant at surgery (indicated with an "X") Please note that for some procedures, the services of a physician as a second assistant at surgery may be needed (indicated with an "O") The indication that a physician would almost never be needed to assist at surgery for some procedures does NOT imply that a physician is never needed The decision to request that a physician assist at surgery remains the responsibility of the primary surgeons and, when necessary, should be a payable service CPT codes and descriptors only are © 2019 American Medical Association October 2020 199 2020 Assistant at Surgery Consensus1 CPT 2020 Descriptor 68550 68700 68705 68720 68745 Excision of lacrimal gland tumor; involving osteotomy Plastic repair of canaliculi Correction of everted punctum, cautery Dacryocystorhinostomy (fistulization of lacrimal sac to nasal cavity) Conjunctivorhinostomy (fistulization of conjunctiva to nasal cavity); without tube Conjunctivorhinostomy (fistulization of conjunctiva to nasal cavity); with insertion of tube or stent Closure of the lacrimal punctum; by thermocauterization, ligation, or laser surgery Closure of the lacrimal punctum; by plug, each Closure of lacrimal fistula (separate procedure) Dilation of lacrimal punctum, with or without irrigation Probing of nasolacrimal duct, with or without irrigation; Probing of nasolacrimal duct, with or without irrigation; requiring general anesthesia Probing of nasolacrimal duct, with or without irrigation; with insertion of tube or stent Probing of nasolacrimal duct, with or without irrigation; with transluminal balloon catheter dilation Probing of lacrimal canaliculi, with or without irrigation Injection of contrast medium for dacryocystography Drainage external ear, abscess or hematoma; simple Drainage external ear, abscess or hematoma; complicated Drainage external auditory canal, abscess Ear piercing Biopsy external ear Biopsy external auditory canal Excision external ear; partial, simple repair Excision external ear; complete amputation Excision exostosis(es), external auditory canal Excision soft tissue lesion, external auditory canal Radical excision external auditory canal lesion; without neck dissection Radical excision external auditory canal lesion; with neck dissection Removal foreign body from external auditory canal; without general anesthesia Removal foreign body from external auditory canal; with general anesthesia Removal impacted cerumen using irrigation/lavage, unilateral Removal impacted cerumen requiring instrumentation, unilateral Debridement, mastoidectomy cavity, simple (eg, routine cleaning) Debridement, mastoidectomy cavity, complex (eg, with anesthesia or more than routine cleaning) Otoplasty, protruding ear, with or without size reduction Reconstruction of external auditory canal (meatoplasty) (eg, for stenosis due to injury, infection) (separate procedure) Reconstruction external auditory canal for congenital atresia, single stage Myringotomy including aspiration and/or eustachian tube inflation Myringotomy including aspiration and/or eustachian tube inflation requiring general anesthesia 68750 68760 68761 68770 68801 68810 68811 68815 68816 68840 68850 69000 69005 69020 69090 69100 69105 69110 69120 69140 69145 69150 69155 69200 69205 69209 69210 69220 69222 69300 69310 69320 69420 69421 Almost Always Sometimes Almost Never X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X This table presents information about the need for a physician as a first assistant at surgery (indicated with an "X") Please note that for some procedures, the services of a physician as a second assistant at surgery may be needed (indicated with an "O") The indication that a physician would almost never be needed to assist at surgery for some procedures does NOT imply that a physician is never needed The decision to request that a physician assist at surgery remains the responsibility of the primary surgeons and, when necessary, should be a payable service CPT codes and descriptors only are © 2019 American Medical Association October 2020 200 2020 Assistant at Surgery Consensus1 CPT 2020 Descriptor 69424 69433 69436 69440 69450 69501 69502 69505 69511 69530 69535 69540 69550 69552 69554 69601 69602 69603 69604 69605 Ventilating tube removal requiring general anesthesia Tympanostomy (requiring insertion of ventilating tube), local or topical anesthesia Tympanostomy (requiring insertion of ventilating tube), general anesthesia Middle ear exploration through postauricular or ear canal incision Tympanolysis, transcanal Transmastoid antrotomy (simple mastoidectomy) Mastoidectomy; complete Mastoidectomy; modified radical Mastoidectomy; radical Petrous apicectomy including radical mastoidectomy Resection temporal bone, external approach Excision aural polyp Excision aural glomus tumor; transcanal Excision aural glomus tumor; transmastoid Excision aural glomus tumor; extended (extratemporal) Revision mastoidectomy; resulting in complete mastoidectomy Revision mastoidectomy; resulting in modified radical mastoidectomy Revision mastoidectomy; resulting in radical mastoidectomy Revision mastoidectomy; resulting in tympanoplasty Revision mastoidectomy; with apicectomy Tympanic membrane repair, with or without site preparation of perforation for closure, with or without patch Myringoplasty (surgery confined to drumhead and donor area) Tympanoplasty without mastoidectomy (including canalplasty, atticotomy and/or middle ear surgery), initial or revision; without ossicular chain reconstruction Tympanoplasty without mastoidectomy (including canalplasty, atticotomy and/or middle ear surgery), initial or revision; with ossicular chain reconstruction (eg, postfenestration) Tympanoplasty without mastoidectomy (including canalplasty, atticotomy and/or middle ear surgery), initial or revision; with ossicular chain reconstruction and synthetic prosthesis (eg, partial ossicular replacement prosthesis [PORP], total ossicular replacement prosthesis [TORP]) Tympanoplasty with antrotomy or mastoidotomy (including canalplasty, atticotomy, middle ear surgery, and/or tympanic membrane repair); without ossicular chain reconstruction Tympanoplasty with antrotomy or mastoidotomy (including canalplasty, atticotomy, middle ear surgery, and/or tympanic membrane repair); with ossicular chain reconstruction Tympanoplasty with antrotomy or mastoidotomy (including canalplasty, atticotomy, middle ear surgery, and/or tympanic membrane repair); with ossicular chain reconstruction and synthetic prosthesis (eg, partial ossicular replacement prosthesis [PORP], total ossicular replacement prosthesis [TORP]) Tympanoplasty with mastoidectomy (including canalplasty, middle ear surgery, tympanic membrane repair); without ossicular chain reconstruction Tympanoplasty with mastoidectomy (including canalplasty, middle ear surgery, tympanic membrane repair); with ossicular chain reconstruction 69610 69620 69631 69632 69633 69635 69636 69637 69641 69642 Almost Always Sometimes Almost Never X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X This table presents information about the need for a physician as a first assistant at surgery (indicated with an "X") Please note that for some procedures, the services of a physician as a second assistant at surgery may be needed (indicated with an "O") The indication that a physician would almost never be needed to assist at surgery for some procedures does NOT imply that a physician is never needed The decision to request that a physician assist at surgery remains the responsibility of the primary surgeons and, when necessary, should be a payable service CPT codes and descriptors only are © 2019 American Medical Association October 2020 201 2020 Assistant at Surgery Consensus1 CPT 69643 69644 69645 69646 69650 69660 69661 69662 69666 69667 69670 69676 69700 69710 69711 69714 69715 69717 69718 69720 69725 69740 69745 69801 69805 69806 69905 69910 69915 69930 2020 Descriptor Tympanoplasty with mastoidectomy (including canalplasty, middle ear surgery, tympanic membrane repair); with intact or reconstructed wall, without ossicular chain reconstruction Tympanoplasty with mastoidectomy (including canalplasty, middle ear surgery, tympanic membrane repair); with intact or reconstructed canal wall, with ossicular chain reconstruction Tympanoplasty with mastoidectomy (including canalplasty, middle ear surgery, tympanic membrane repair); radical or complete, without ossicular chain reconstruction Tympanoplasty with mastoidectomy (including canalplasty, middle ear surgery, tympanic membrane repair); radical or complete, with ossicular chain reconstruction Stapes mobilization Stapedectomy or stapedotomy with reestablishment of ossicular continuity, with or without use of foreign material; Stapedectomy or stapedotomy with reestablishment of ossicular continuity, with or without use of foreign material; with footplate drill out Revision of stapedectomy or stapedotomy Repair oval window fistula Repair round window fistula Mastoid obliteration (separate procedure) Tympanic neurectomy Closure postauricular fistula, mastoid (separate procedure) Implantation or replacement of electromagnetic bone conduction hearing device in temporal bone Removal or repair of electromagnetic bone conduction hearing device in temporal bone Implantation, osseointegrated implant, temporal bone, with percutaneous attachment to external speech processor/cochlear stimulator; without mastoidectomy Implantation, osseointegrated implant, temporal bone, with percutaneous attachment to external speech processor/cochlear stimulator; with mastoidectomy Replacement (including removal of existing device), osseointegrated implant, temporal bone, with percutaneous attachment to external speech processor/cochlear stimulator; without mastoidectomy Replacement (including removal of existing device), osseointegrated implant, temporal bone, with percutaneous attachment to external speech processor/cochlear stimulator; with mastoidectomy Decompression facial nerve, intratemporal; lateral to geniculate ganglion Decompression facial nerve, intratemporal; including medial to geniculate ganglion Suture facial nerve, intratemporal, with or without graft or decompression; lateral to geniculate ganglion Suture facial nerve, intratemporal, with or without graft or decompression; including medial to geniculate ganglion Labyrinthotomy, with perfusion of vestibuloactive drug(s), transcanal Endolymphatic sac operation; without shunt Endolymphatic sac operation; with shunt Labyrinthectomy; transcanal Labyrinthectomy; with mastoidectomy Vestibular nerve section, translabyrinthine approach Cochlear device implantation, with or without mastoidectomy Almost Always Sometimes Almost Never X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X This table presents information about the need for a physician as a first assistant at surgery (indicated with an "X") Please note that for some procedures, the services of a physician as a second assistant at surgery may be needed (indicated with an "O") The indication that a physician would almost never be needed to assist at surgery for some procedures does NOT imply that a physician is never needed The decision to request that a physician assist at surgery remains the responsibility of the primary surgeons and, when necessary, should be a payable service CPT codes and descriptors only are © 2019 American Medical Association October 2020 202 2020 Assistant at Surgery Consensus1 CPT 69950 69955 69960 69970 69990 2020 Descriptor Vestibular nerve section, transcranial approach Total facial nerve decompression and/or repair (may include graft) Decompression internal auditory canal Removal of tumor, temporal bone Microsurgical techniques, requiring use of operating microscope (List separately in addition to code for primary procedure) Almost Always Sometimes Almost Never X X X X X This table presents information about the need for a physician as a first assistant at surgery (indicated with an "X") Please note that for some procedures, the services of a physician as a second assistant at surgery may be needed (indicated with an "O") The indication that a physician would almost never be needed to assist at surgery for some procedures does NOT imply that a physician is never needed The decision to request that a physician assist at surgery remains the responsibility of the primary surgeons and, when necessary, should be a payable service CPT codes and descriptors only are © 2019 American Medical Association October 2020 203