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Thread: What gets reimbursed?

  1. #1

    Default What gets reimbursed?

    AAPC: Back to School
    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?


  2. #2
    Join Date
    Apr 2007
    North Carolina


    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).


    Section 20.4.3 and 110.1

  3. #3


    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
    Join Date
    Apr 2007


    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:

    Pam Tienter, CPC, COC, CPC-P, CCS-P, CPMA, CPC-I
    AHIMA Approved ICD-10-CM/PCS Trainer
    AAPC National ICD-10-CM Trainer

  5. #5
    Join Date
    Apr 2007
    North Carolina


    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


  6. #6


    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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