Forum - Questions & Answers

Jan 6th, 2011 - jschmutz   323 

Can you charge a Self-Pay patient for an assist when CMS doesn't allow an assist?

Can a practice charge a self-pay patient for an assistant when normally an assistant isn't allowed?

 



For example, CPT® 64483 has an assistant modifier of "1" which means:


1=Statutory payment restriction for assistants at surgery applies to this
procedure. Assistant at surgery may not be paid.

 



Can a practice bill the patient for the primary provider (64483) as well as for the assistant (64483-81) when the patient is self-pay, even though CMS says an assistant may not be paid?

 


What if the payer was a private payer? Would you still report the charge for the assistant?

Thanks in advance!

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Jan 7th, 2011 - jschmutz   323 

Can you charge a Self-Pay patient for an assist when CMS doesn't allow an assist?

Moving this back to the top...

Can a practice charge a self-pay patient for an assistant when normally an assistant isn't allowed?



For example, CPT® 64483 has an assistant modifier of "1" which means:

1=Statutory payment restriction for assistants at surgery applies to this procedure. Assistant at surgery may not be paid.


Can a practice bill the patient for the primary provider (64483) as well as for the assistant (64483-81) when the patient is self-pay, even though CMS says an assistant may not be paid?



What if the payer was a private payer? Would you still report the charge for the assistant?
Thanks in advance!

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Jan 7th, 2011 -

Yes

you can do whatever you want...but really? You are going to penalize a cash-paying patient by overcharging them? Insurers do not allow you to bill for assistants because there is no medical reason to have one other than convenience. Make their bill too high and you'll get nothing.

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Jan 7th, 2011 - jschmutz   323 

Charging for an Assist just because you can

I agree, but this client wants us to bill for the assistant on everything. How an assistant really assisted with an injection is beyond me. Did one of them push the needle in and the other push in the plunger? Or was the assistant just there to provide mental support for the physician? I was hoping there was something which stated that it was inappropriate to charge for an assistant just because the patient was self-pay. Oh well. Sounds like they are perfectly legal to do it. Thanks for the response.

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Jan 8th, 2011 -

So

if the client wants you to bill the assistant on everything and you know it is wrong, is this the kind of client you want? Will you be indicted for Medicare fraud too? Can you say you were "just" coding what they presented you??? Not to say that this is fraud but docs like this get awfully close to the line sometimes...

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