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The rules say that plans must pay for a medical service or item if regular Medicare would pay for it in this case. 
You can find this rule at 42 Code of Federal Regulations (CFR) Section 422.101. 
 
The rules say that procedures with a status indicator of 1 are not eligible for assistant at surgery 
reimbursement. Assistant surgeon may not be paid. Assistant at Surgery (Modifiers AS, 80, 81 and 82) 
1 = Statutory payment restriction for assistants at surgery applies to this procedure. Assistant at surgery 
may not be paid. You can find Medicare guidance in the National Physician Fee Schedule Relative Value File  
January release. 
 
The rules say that for Add-on code-20700; appropriate Primary Codes-11010, 11011, 11012, 11043, 11044, 
11046, 11047, 20240, 20250, 20245, 20251, 21010, 21025, 21026, 21501, 21502, 21510, 21627, 21630, 22010, 
22015, 23030, 23031, 23035, 23040, 23044, 23170, 23172, 23174, 23180, 23182, 23184, 23334, 23335, 23930, 
23931, 23935, 24000, 24134, 24136, 24138, 24140, 24147, 24160, 25031, 25035, 25040, 25145, 25150, 25151, 
26070, 26230, 26235, 26236, 26990, 26991, 26992, 27030, 27070, 27071, 27090, 27301, 27303, 27310, 27360, 
27603, 27604, 27610, 27640, 27641, 28001, 28002, 28003, 28020, 28120, 28122. You can find this 
information in the Final Complete File of Add-On Code for Medicare, Type I-Cpt Manual, HCPCS Manual, 
And or CMS Policy Defines All Acceptable Primary Codes. 
 
The rules say that ZZZ = Code related to another service and is always included in the global period of the 
other service. (Note: Physician work is associated with intra-service time and in some instances the post service 
time.) You can find this information in the Medicare Claims Processing Manual Chapter 23 - Fee Schedule 
Administration and Coding Requirements, Addendum- Medicare Physician Fee Schedule Database (MPFSDB) Record Layouts File Layout. 
 
Medicare Guidance Says CMS.GOV Add-on Code Edits: An AOC is a HCPCS/CPT code that describes 
a service that, with rare exception, is performed in conjunction with another primary service by the same 
practitioner. An AOC is rarely eligible for payment if it is the only procedure reported by a practitioner. 
Add-on codes may be identified in three ways: 
1. The code is listed in this CR or subsequent ones as a Type I, Type II, or Type III add-on code. 
2. On the Medicare Physician Fee Schedule Database an add-on code generally has a global surgery 
period of "ZZZ". 
3. In the CPT Manual an add-on code is designated by the symbol "+". The code descriptor of an add- 
on code generally includes phrases such as "each additional" or "(List separately in addition to primary 
procedure). 
CMS has divided the add-on codes into three groups to distinguish the payment policy for each group. 
1. Type I - A Type I add-on code has a limited number of identifiable primary procedure codes. The CR 
lists the Type I add-on codes with their acceptable primary procedure codes. A Type I add-on code, 
with one exception, is eligible for payment if one of the listed primary procedure codes is also eligible 
for payment to the same practitioner for the same patient on the same date of service. Claims processing 
contractors must adopt edits to assure that Type I add-on codes are never paid unless a listed primary 
procedure code is also paid. You can find this information on https://www.cms.gov/medicare-medicaid-
coordination/national-correct-coding-initiative-ncci/ncci-medicare/medicare-ncci-add-code-edits 
 
If you want to read these Medicare rules, you can go to this website www.medicareappeal.com.