Having billed for many practice and surgical specialties, as well as ASC and Hospitals throughout my extensive healthcare career, I find surgical assisting is a very unique area and comes with some of the most challenging denial tactics by commercial carriers. There are many billing companies that provide surgical assistant billing, however based on my research, very few surgical assisting billing companies provide appeal services or effective appeal services. I provide billing services for surgical assistants and have for over 13 years, and I have specialized in Out of Network billing for more years than that. As it pertains to your question, RNFA's do not qualify as a covered mid-level for Medicare reimbursement. Although Medicaid is governed under CMS, you will need to check with your state Medicaid program for specific coverage information. However, even though commercial carriers may not credential certain mid-levels (ie CSA, RNFA, etc), surgical assistants are still allowed to bill commercial payers as out of network providers. As an ERISA/PPACA Claims Handling Compliance and Appeal Specialist providing billing for surgical assistants on the side, I have been successful in getting many surgical assistant claim denials covering a variety of denial tactics, overturned and paid on a regular basis. The key is understanding surgical assistant billing rights, relevant claims handling compliance related laws and utilizing provider rights that help address improper insurance denial tactics.