Wiki Surgery Assist non payable procedures

[sharon2014]

Where can I get a list of all procedures that aren't AS payable?

TIA

Sharon, CPC
General Surgery and Hospitalist

 

[CodingKing]

You could download the Medicare RVU file. There is an assistant surgeon indicator on each code

https://www.cms.gov/medicare/medica...ysicianfeesched/pfs-relative-value-files.html

Use the file in the zip file named PPRRVU16_V0122 for one your spreadsheet application supports (xlsx, csv, or text)

0 = Payment restrictions for assistants at surgery applies to this procedure unless supporting documentation is submitted to establish medical necessity.
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.

 

[hopepg]

I haven't used the download before but that looks like a great tool also! Thank you!

I use the CMS fee schedule tool:
https://www.cms.gov/apps/physician-fee-schedule/search/search-criteria.aspx

Just plug in the specifics & I click for "payment policy indicators" since I am just looking for assistant surgery coverage.

Then just depending on if the indicator is 0, 1 or 2 (explained in previous post) on what to do from there.