Assistance payable?

CMS maintains a data base that provides an incredible amount of data beyond the fee schedule look up. One category it covers is CMS' allowance for a surgical assistant.

If you look at the CMS database for fee schedule look up (https://www.cms.gov/medicare/physician-fee-schedule/search

this site provides a breakdown by column on how a fee is dervied.

One such column far to the right is the allowance of surgical assistants.

One can search by contractor or simply the national allowed amount for a specific AMA-CPT and by year.

Under the column for Surgical Assistant one will find the following notations and their meanings:If the indicator is "0,": payment for an assistant at surgery is restricted unless supporting documentation establishes medical necessity. 

• If the indicator is "2,": payment for an assistant at surgery is generally allowed. 

• If the indicator is "1,": statutory payment restrictions apply, and assistant at surgery services may not be paid. 

• Thus for example 11730 (nail avulsion) has a 1 as its indicator whereas 28800 (Chopart Amputation) has a 2 indicating payment for a surgical assistant is allowed.

• If however, a salaried staff member (PA, NP or other MD/DO/DPM) from the facility is paid then they cannot bill the Medicare contractor (double dipping).

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