# Surg Reimb Brkout for both Doc & PA/NP Assting



## schweitzerm (Jun 19, 2012)

Good evening!  I'm very new to all of this, especially Medicare rules and regs, so I am very grateful for any help.  My question - if a surgeon has an NP or PA as a surgical assistant,  how is reimbursement broken out under Medicare? My meager understanding is that the PA/NP would receive 16% of the surgeon's allowable reimbursement.  Does this mean that the doc gets the balance of the allowable?  This question may sound stupid, but I haven't been able to find any sort of language on CMS to show a break out.  Perhaps, I don't know enough about Medicare "speak" to understand what they mean.  Any help would be most appreciated.


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## elizabeth.field@shcr.com (Jun 19, 2012)

I believe that the payment is not carved out of the surgeon's fee, but that the assistant gets 16% of the allowable for the surgery - if they are a PA.   An MD or DO would get 25%, as I understand it.  If I am wrong, hopefully someone else will join in the conversation and correct me.


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## schweitzerm (Jun 20, 2012)

Thank you, Elizabeth, for your prompt response.  If Medicare doesn't carve out PA/NP reimbursements from total Medicare reimbursable from the doc, are there any other payers/carriers that do?

Thanks again for your time and expertise


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## mhstrauss (Jun 21, 2012)

I agree with the above response.  We bill for PA/NP's pretty much daily, to a variety of payers, and I'm not aware of any of them "carving out" part of the primary surgeons' fee to pay the assist.

Hope this helps!


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## JMeggett (Jun 21, 2012)

schweitzerm said:


> Good evening!  I'm very new to all of this, especially Medicare rules and regs, so I am very grateful for any help.  My question - if a surgeon has an NP or PA as a surgical assistant,  how is reimbursement broken out under Medicare? My meager understanding is that the PA/NP would receive 16% of the surgeon's allowable reimbursement.  Does this mean that the doc gets the balance of the allowable?  This question may sound stupid, but I haven't been able to find any sort of language on CMS to show a break out.  Perhaps, I don't know enough about Medicare "speak" to understand what they mean.  Any help would be most appreciated.



There is a Medicare Part B Bulletin about this. Pub 100-04, Chapter 12, Section 110.3 posted 01/30/12.  It says to bill for a PA Assistant at Surgery  with modifiers -AS, -80...in that order.  The Surgeon gets paid his full amount on his Claim, then the PA's claim gets paid 85% of 16% of the full allowable for the CPT.  (Confused yet!?)  So for CPT 29881, the allowable right now is $588.52.  The Surgeon would get paid $588.52 on his claim.  The PA would get paid $80.05 on their claim.   $588.52 x 16% = $94.17.  Then $94.17 x 85% = $80.05.    Hopefully this helps!
Jenna


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## schweitzerm (Jun 21, 2012)

Got it!  It actually does make perfect senses and absolutely answers my questions. It has been very helpful!  I appreciate your time AND knowledge


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