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What gets reimbursed?

  1. #1
    Default What gets reimbursed?
    Medical Coding Books
    I was wondering if anyone knows what % that the co-surgeon gets reimbursed, in general?

    We were thinking 60%, 80% or 30% and are not sure which one is correct because we have heard all three.

    Any suggestions?

    Thanks.

  2. #2
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    North Carolina
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    For assistant at surgery services performed by physicians, the fee schedule amount equals 16 percent of the amount otherwise applicable for the global surgery. (Modifier 80)


    The carrier shall pay covered PA assistant at surgery services at 85 percent of the 16 percent of the physician fee schedule amount (i.e., 10.4 percent).

    http://www.cms.hhs.gov/manuals/downloads/clm104c12.pdf

    Section 20.4.3 and 110.1

  3. #3
    Default
    Well, I know what an assistant surgeon gets reimbursed but I didn't know if a co-surgeon would be paid the same reimbursement. Because the co-surgeon is doing more of the surgery than an assistant would.

    Anything further?

  4. #4
    Default
    Medicare reimburses 62.5% of the allowable to a cosurgeon. I'm not sure exactly where this is on the CMS website but I have local link:

    http://www.wpsmedicare.com/part_b/ed...odifier_62.pdf
    Pam Tienter, CPC, COC, CPC-P, CCS-P, CPMA, CPC-I, AAPC Fellow
    AHIMA Approved ICD-10-CM/PCS Trainer
    AAPC National ICD-10-CM Trainer

  5. #5
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    North Carolina
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    3,126
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    ohhhhh...missed that. Yep...For co-surgeons (modifier 62), the fee schedule amount applicable to the payment for each co-surgeon is 62.5 percent of the global surgery fee schedule amount. Team surgery (modifier 66) is paid for on a “By Report” basis.

    40.8. B

    http://www.cms.hhs.gov/manuals/downloads/clm104c12.pdf

  6. #6
    Default
    Thanks for your input! I appreciate it. 62.5% is more than I was thinking. That's good.

    Have a good one.

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