Assistant Surgeon on CPT 61323

October 27, 2016

Question:
We got a denial for assistant surgery charges by our PA for CPT 61323 with the reason as Medicare disallows. I looked at Medicare’s guidelines and confirmed this. It seems rather odd that they would not pay for assist on brain surgery but routinely do on laminectomies and discectomies. What are your thoughts?

Answer:
I also looked at Medicare’s guidelines and saw that Medicare does allow an assistant to be paid on CPT 61322 but not on 61323. This didn’t seem right to me – perhaps an oversight when the codes were introduced in 2003.

So I asked the neurosurgery specialty societies to help rectify the issue. Success! They were able to get Medicare to approve 61323 for assistant surgery payment (modifier 80, 82, AS). Thank you for being an “eagle-eyed administrator”!

*This response is based on the best information available as of 10/27/16.

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