Wiki RNFA Question

[kfusco]

If a surgeon hires an RNFA and the surgery allows for an assist can you bill for a RNFA? Also, I know in the past Medicare and Medicaid were not reimbursing for RNFA's is this still the case?

Thank you.

 

[CBLENNIE]

Based on the current version of Medicare Claims Processing Manual 100-04 Chapter 12 Physicians/Nonphysician Practitioners section 20.4.3 Assistant-at Surgery-Services indicates that Medicare only covers assistant-at-surgery services to be provided by a physician, physicians assistant (PA), nurse practitioners (NP) and clinical nurse specialists (CNS). So, Medicare is still not reimbursing RNFAs for assistant surgeon services, this applies to Medicare Advantage (MA) plans as well. You would need to check with your state's Medicaid provider manual/policies to see if they are now reimbursing RNFAs for these services.

For commercial insurance companies you are going to have to check with the individual carriers to determine if they reimburse RNFAs. The commercial insurance company I work for follows Medicare and we do not pay for the assistant surgeon services for an RNFA, as well as CSAs. Typically, the services of an RNFAs are considered as similar to the OR staff employed/provided by the facility and that is why a lot of payers do not separately reimburse charges for an RNFA, it is considered inclusive in the facility's fees for the use of the OR.

 

[kfusco]

Based on the current version of Medicare Claims Processing Manual 100-04 Chapter 12 Physicians/Nonphysician Practitioners section 20.4.3 Assistant-at Surgery-Services indicates that Medicare only covers assistant-at-surgery services to be provided by a physician, physicians assistant (PA), nurse practitioners (NP) and clinical nurse specialists (CNS). So, Medicare is still not reimbursing RNFAs for assistant surgeon services, this applies to Medicare Advantage (MA) plans as well. You would need to check with your state's Medicaid provider manual/policies to see if they are now reimbursing RNFAs for these services.

For commercial insurance companies you are going to have to check with the individual carriers to determine if they reimburse RNFAs. The commercial insurance company I work for follows Medicare and we do not pay for the assistant surgeon services for an RNFA, as well as CSAs. Typically, the services of an RNFAs are considered as similar to the OR staff employed/provided by the facility and that is why a lot of payers do not separately reimburse charges for an RNFA, it is considered inclusive in the facility's fees for the use of the OR.

Thank you so very much for your help