Assistant Surgeon Payable on Particular CPTs?

RVOSKANI

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Hello!

I am using the CMS Physician Fee Schedule Search on the CMS website to look up if an assistant surgeon is allowed for certain CPT codes.

Anyhow, I cannot find any “key” to tell me what these numbers mean. I know “0” in the ASST SURG field below means the assistant surgeon will not get paid on this code, but what does a “2” mean? I have hunted around and read the help file, and I called Medicare help line 3 times today to try to get this answered, suffice it to say the people had no clue.

The CPT is 69990. How can I tell whether or not Medicare will pay for Assistant Surgeon??

https://www.cms.gov/apps/physician-fee-schedule/search/search-results.aspx?Y=0&T=1&HT=0&H1=69990&M=5

General look up:

https://www.cms.gov/apps/physician-fee-schedule/search/search-criteria.aspx

Can anyone Help???
 

RebeccaWoodward*

True Blue
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North Carolina
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Hello!

I am using the CMS Physician Fee Schedule Search on the CMS website to look up if an assistant surgeon is allowed for certain CPT codes.

Anyhow, I cannot find any “key” to tell me what these numbers mean. I know “0” in the ASST SURG field below means the assistant surgeon will not get paid on this code, but what does a “2” mean? I have hunted around and read the help file, and I called Medicare help line 3 times today to try to get this answered, suffice it to say the people had no clue.

The CPT is 69990. How can I tell whether or not Medicare will pay for Assistant Surgeon??

https://www.cms.gov/apps/physician-fee-schedule/search/search-results.aspx?Y=0&T=1&HT=0&H1=69990&M=5

General look up:

https://www.cms.gov/apps/physician-fee-schedule/search/search-criteria.aspx

Can anyone Help???
You're on the right track. Medicare's fee schedule schedule does allow payment for an assistant BUT only for specific codes.

"F. Operating Microscope

1. The Internet-Only Manuals (IOM), Medicare Claims Processing Manual, Publication 100-04, Chapter 12, Section 20.4.5 (Allowable Adjustments) limits the reporting of use of an operating microscope (CPT code 69990) to procedures described by CPT codes 61304-61546, 61550-61711, 62010-62100, 63081-63308, 63704-63710, 64831, 64834-64836, 64840-64858, 64861-64870, 64885-64891 and 64905-64907. CPT code 69990 should not be reported with other procedures even if an operating microscope is utilized. CMS guidelines for payment of CPT code 69990 differ from CPT Manual instructions following CPT code 69990. The NCCI bundles CPT code 69990 into all surgical procedures other than those listed in the Medicare Claims Processing Manual. Most edits do not allow use of NCCI-associated modifiers.

Open the NCCI Policy Manual:


http://www.cms.gov/Medicare/Coding/...ect=/NationalCorrectCodInitEd/NCCIEP/list.asp
 

katmarbar

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If you're still looking, they're called key status indicators:

Assistant at Surgery
0 Payment restriction applies to this procedure unless supporting documentation is submitted to
establish medical necessity.
1 Statutory restriction: Assistant at surgery may not be paid.
2 Payment restriction does not apply: Assistant at surgery may be paid.
9 Concept does not apply.
 
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