Wiki CMS Guidelines for more than one surgical assist

[emcneill]

Hi - Can anyone tell me if a provider can charge a patient for a second surgical assist if Medicare only allows for one surgical assist? The patient would sign an ABN with option 1, stating we will bill Medicare, but if they deny 2nd surgical assist they will be responsible for charges.

 

[thomas7331]

This situation does not meet the criteria for use of an ABN. An ABN is primarily used for situations where an item or service is not a covered benefit, usually due to the patient's diagnosis not meeting medical necessity criteria or due to exceeding the allowed number of services in a given time period. (There are other situations but these are probably the most common for physician services). Its purpose is to notify the patient that the service is not a benefit; it is not for use to allow providers to bill patients for other types of denials that are not related to coverage limitations.

Medicare's policy for only allowing one surgical assistant is a reimbursement policy, it is not a benefit coverage policy. You cannot bill patients for services denied under reimbursement policy, with or without an ABN.