April 13, 2017
Is there a difference in billing and especially reimbursement for a registered nurse FA (first assistant) vs. a formal mid-level provider (PA, etc.)?
Yes, there is a difference in how these two types of practitioners can be billed and expected reimbursement. The answer will be payor dependent.
Physician Assistants, Nurse Practitioners and Clinical Nurse Specialists
Medicare credentials only Physician Assistants (PA), Nurse Practitioners (NP), and Clinical Nurse Specialists (CNS) as assistants at surgery for the purpose of orthopaedic surgery. Assistant claims are reported in the PA, NP or CNS name with the AS appended. Medicare, when payment is allowed, reimburses the practice at 13.6% of the surgeon’s allowable for the primary procedure. The appropriate multiple procedure payment formula is applied to the subsequent procedures on the same day.
Other payors may or may not follow Medicare rules. Reimbursement and claim submission are based on contractual arrangements. Check individual payor rules for claim submission rules (e.g. modifier use, separate claim) and expected reimbursement.
RNFAs are not credentialed by Medicare, so you would not bill or expected to be paid for their work by the MAC.
Other payor rules for RNFA coverage/reimbursement will vary, and would need to be researched directly with the health plans in your market.
*This response is based on the best information available as of 04/13/17.