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Wiki Surgery Assist non payable procedures

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sharon2014

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Where can I get a list of all procedures that aren't AS payable?

TIA

Sharon, CPC
General Surgery and Hospitalist
 
You could download the Medicare RVU file. There is an assistant surgeon indicator on each code

https://www.cms.gov/medicare/medica...ysicianfeesched/pfs-relative-value-files.html

Use the file in the zip file named PPRRVU16_V0122 for one your spreadsheet application supports (xlsx, csv, or text)

0 = Payment restrictions for assistants at surgery applies to this procedure unless supporting documentation is submitted to establish medical necessity.
1 = Statutory payment restriction for assistants at surgery applies to this procedure. Assistant at Surgery may not be paid.
2 = Payment restrictions for assistants at surgery does not apply to this procedure. Assistant at Surgery may be paid.
 
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I haven't used the download before but that looks like a great tool also! Thank you!

I use the CMS fee schedule tool:
https://www.cms.gov/apps/physician-fee-schedule/search/search-criteria.aspx

Just plug in the specifics & I click for "payment policy indicators" since I am just looking for assistant surgery coverage.

Then just depending on if the indicator is 0, 1 or 2 (explained in previous post) on what to do from there.
 
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