Forum - Questions & Answers

Nov 18th, 2009 - ccarnan

Reimbursement for Co-surgery

My provider does not participate with commercial insurance companies. He bills as a co-surgeon, when it comes to reimbursement for the procedure. Do we have to follow the co-surgery reimbursement of 62.5% or we can negotiate a higher reimbursement?

Nov 18th, 2009 - Codapedia Editor 1,399 

reimbursement

If you don't participate, with whom are you negotiating?

Nov 19th, 2009 -

Reimbursement for Co-sugery

Third-party vendors acting on the behalf of the insurance company.

Nov 19th, 2009 - Codapedia Editor 1,399 

reimbursement for co-surgery

It's not clear to me why you negotiate when you don't participate.

CPT provides coding and not reimbursement rules, of course. CMS and other payers set reimbursement policy. CMS's policy is the 62.5% for co-surgery, assuming the surgery has a co-surgery indicator in the fee schedule.

I don't know of any other written justification for another amount.



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