Wiki Surgical assistant


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There is a new surgical assistant that works in our office and he wants me to bill claims for him along the lines of incident to - I explained I could not do this since he does not have an NPI# and according to the major carriers they don't reimburse for surgical assistants. Does anyone have experience with this?

If the he is employed by the physician, his services performed in the office may be billed as 'incident to' if they are within the scope of practice, meet the definition of 'incident to' and are appropriately supervised by the MD, just as with all other ancillary staff services. But you cannot bill for any services performed in a facility, e.g. if he is assisting in the OR of a hospital - 'incident to' is not allowed in that setting. What services exactly would he be performing in the office? Surgical assistants are usually just trained to assist in a surgery setting and do not perform office services.
So far he has just been assisting in the OR but there was hope he could function like our PA's and see patients for routine follow-ups/injections etc.
As long as he is performing duties within the scope of the license as defined by your state, and as long as the 'incident to' and supervision requirements are met, I think you could bill these services. However, I don't believe it would be appropriate to bill higher than a 99211 level of E&M for this provider type.