Charlene Posted Fri 16th of August, 2019 13:16:56 PM
Hello, Can you point me to any guidelines regarding billing for assistant at surgery on unlisted procedures? I've searched, but am unable to find anything at present. I believe I've read that insurance may or may not reimburse assist on unlisted procedures. My current claim is specific to Medicare.
SuperCoder Answered Mon 19th of August, 2019 10:05:29 AM
Thanks for your question.
There are several categories of unlisted procedures regarding the payment of assistant at surgery:
- Some codes pay assistant at surgery. It means payment restriction for assistants at surgery does not apply to these procedures. Assistant at surgery may be paid e.g. CPT code 33999.
- Some codes pay but when supported. It means payment restriction for assistants at surgery applies to this procedure unless supporting documentation is submitted to establish medical necessity. e.g. CPT code 29799.
- Some codes do not pay at all. It means statutory payment restriction for assistants at surgery applies to this procedure. Assistant at surgery may not be paid e.g. CPT code 47999.
Note: Please check for Fee Schedule Indicator given by CMS. If a CPT code does have an indicator 2, then it may be paid by the Medicare.
Please feel free to write if you have any question.