Wiki CPT 29806- Payment Indicator

[Ritukap11]

Hi

CPT code- 29806
Payment Indicator 1 – Statutory payment restriction for assistants at surgery applies to this procedure. Assistant at surgery may not be paid.

Does the word may means that its upto the payor to decide to pay or not?

Thank you

 

[amyjph]

It means that it is not allowed. Will not be paid. It means NO.
Some payers *might* cover assistant at surgery if they do not follow CMS. (Rare)

Status definitions​

0 = Payment restrictions for assistants at surgery applies to this procedure unless supporting documentation is submitted to establish medical necessity.
Note: Supporting documentation must be submitted at the time of claim submission to established medical necessity and should clearly document the assistant surgeon's role during the operative session.

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.
9 = Concept does not apply

This is just an example policy for Anthem: https://providernews.anthem.com/ohi...ery-modifiers-80-81-82-as-professional-3-9488
Most of the time they are named Assistant Surgeon List or something like that if they differe from CMS.

 

[Ritukap11]

It means that it is not allowed. Will not be paid. It means NO.
Some payers *might* cover assistant at surgery if they do not follow CMS. (Rare)

Status definitions​

0 = Payment restrictions for assistants at surgery applies to this procedure unless supporting documentation is submitted to establish medical necessity.
Note: Supporting documentation must be submitted at the time of claim submission to established medical necessity and should clearly document the assistant surgeon's role during the operative session.

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.
9 = Concept does not apply

This is just an example policy for Anthem: https://providernews.anthem.com/ohi...ery-modifiers-80-81-82-as-professional-3-9488
Most of the time they are named Assistant Surgeon List or something like that if they differe from CMS.

Thank You!