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RN Assists in Procedures

Oscar Posted Wed 11th of July, 2018 18:39:40 PM
Hello, we were wondering if a RN assists in a procedure, are we able to bill for it? If so, what documentation needs to be present in the operative note and how would this be billed out?
SuperCoder Answered Thu 12th of July, 2018 10:19:15 AM

Hi Oscar,

Registered nurse first assistants (RNFA) are eligible for reimbursement when providing surgical assist services for surgeries that justify an assist. Eligibility for reimbursement is applicable to all products, unless a procedure is not covered under a contract or benefit plan. Bill an RNFA surgical assisstant procedure using AS modifier. 

Please feel free to ask, if you have any questions.



Oscar Posted Thu 12th of July, 2018 10:38:56 AM
Thank you. Is there a listing of what surgeries are eligible? We are a gastroenterology practice who have GI techs assist in the procedures but are possibly looking into hiring a RN to assist and thinking of billing out for the cases she assists in. Is the RNFA then a different credential than a RN? Thank you.
SuperCoder Answered Fri 13th of July, 2018 07:04:13 AM


  • Yes, RNFA and RN credential are different. A Registered Nurse First Assistant (RNFA) is a registered nurse who has completed a minimum of 2000 hours of first assisting a physician with surgery and related preoperative, intraoperative, and postoperative care, and certified by recognized organization. A Registered Nurse (RN) assess patient health problems and needs, develop and implement nursing care plans, and maintain medical records. Administer nursing care to ill, injured, convalescent, or disabled patients. May advise patients on health maintenance and disease prevention or provide case management.
  • Currently, Medicare does not reimburse RNFAs. Florida Medicaid reimburses RNFAs, and in some states, private payers are required by law to reimburse RNFAs. These states include Florida, Georgia, Kentucky, Louisiana, Maine, Minnesota, Rhode Island, Texas, Washington, and West Virginia. In other states, RNFAs are not reimbursed.
  • However, Medicare reimburses assistant-at-surgery services if the assistant is a nurse practitioner, physician assistant, or clinical nurse specialist; if the surgery is one for which an assistant is reasonable and medically necessary; and if the hospital is not a teaching hospital. The conditions for coverage of assistant-at-surgery services in teaching hospitals are more restrictive than those in other settings because of the availability of residents who are qualified to perform this type of service. Medicaid and the commercial payers also usually reimburse assistant-at-surgery services when medically necessary and reasonable and when performed by a physician, advanced practice nurse, or physician assistant.
  • Some advanced practice nurses who want to assist at surgery complete an RNFA program and become certified as an RNFA. These clinicians generally are being reimbursed because they are advanced practice nurses.
  • Medicare calculates payment for assistant-at-surgery services according to the following formula: when the assistant is a physician, payment is the facility-specific Medicare Physician Fee Schedule amount multiplied by the assistant-at-surgery reduction percent (16%), minus deductible and coinsurance, multiplied by 115%. In the case of a physician assistant, nurse practitioner, or clinical nurse specialist, the amount paid for serving as an assistant-at-surgery is the lesser of the actual charge or 85% of the amount that would otherwise be recognized if a physician had served as the assistant-at-surgery.
  • The procedure which have Medicare Physician Fee Schedule status 2 in modifier AS column, are eligible for billing.

Hope this answers the questions.

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