![]() “I understand that section 1842(b)(7)(D) of the Social Security Act generally prohibits Medicare physician fee schedule payment for the services of assistants at surgery in teaching hospitals when qualified residents are available to furnish such services. Medicare requires the following attestation in the operative report: In these cases, claims should be accompanied by an explanation that the first assist was medically necessary and that no qualified resident was available to first assist at that time. If the primary surgeon has a policy of never allowing residents to act as assistants, or in trauma cases, or if the surgeon believes that the resident is not the best individual to perform the service, Medicare will reimburse for a PA first assistant. If a teaching hospital has an approved and accredited surgical training program related to the surgery being performed and has a qualified resident available to perform the service, no reimbursement is made for a PA first assisting. There are no restrictions for other services PAs provide. In teaching hospitals, Medicare restricts coverage of PAs for first assisting at surgery. There is also an excerpt called “Surgical Assistants” from the American College of Surgeons Statements on Principles regarding the qualifications of surgical assistants, including non-physician providers. You may also consult the Physicians as Assistants at Surgery 2016 Update, which assigns all surgeries with CPT codes a ranking of whether or not they require a physician as a first assistant: 1 - almost always, 2 - almost never, or 3 - some of the time. PAs are eligible for reimbursement for first assisting in any procedure where a physician would receive such reimbursement (American Association of Physician Assistants)(CMS). Job satisfaction will help with employee recruiting and retention leading to less turnover. Varying the PA’s schedule with clinic, procedures, inpatient work, and OR time can be very rewarding. ![]() Encouraging professional development and growth by perfecting a new skill can boost morale and job satisfaction. ![]()
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