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Medicare: First Assisting at Surgery
2005 Surgical Denial List
Coverage of PAs who are first assisting at surgery is provided at 85 percent of the physician's first-assisting fee. Medicare will reimburse a physician who first assists at the rate of 16 percent of the primary surgeon's fee. PA first assists are covered at 85 percent of 16 percent (which is 13.6 percent of the primary surgeon's fee). PAs can provide the same range of first-assist duties as physicians. Of course, PAs cannot act as primary surgeons.
PAs should be aware of the Medicare list of approximately 1,900 CPT codes for which a first assistant at surgery will not be reimbursed. These code restrictions apply to PAs, physicians, and other health care professionals covered for first assisting under Medicare. A list of the affected CPT codes is available from your local Medicare carrier.
Below is Medicare's 2005 National list of restricted codes. Your local Medicare carrier may modify this list based on needs in your state. Contact your local carrier to obtain the current list that is in effect in your state.
Not Payable Under Medicare for 2005
CPT/HCPCS CPT/HCPCS CPT/HCPCS CPT/HCPCS CPT/HCPCS CPT/HCPCS CPT/HCPCS CPT/HCPCS CPT/HCPCS G0104 11440 12006 15101 16036 19330 21032 23180 24650 G0105 11441 12007 15120 17000 19340 21040 23350 24655 G0105 11442 12011 15121 17003 19350 21079 23415 24670 G0121 11443 12013 15200 17004 19370 21080 23480 24675 G0121 11444 12014 15220 17106 19371 21089 23500 25000 G0127 11446 12015 15221 17107 19380 21110 23505 25001 G0168 11450 12016 15240 17110 20000 21116 23540 25020 G0268 11470 12020 15241 17111 20005 21120 23570 25024 10040 11600 12021 15260 17250 20101 21210 23600 25028 10060 11601 12031 15261 17260 20200 21215 23605 25065 10061 11602 12032 15342 17261 20205 21235 23620 25066 10080 11603 12034 15343 17262 20206 21248 23625 25075 10081 11604 12035 15350 17263 20220 21282 23650 25076 10120 11606 12036 15351 17264 20225 21310 23655 25077 10121 11620 12041 15400 17266 20240 21315 23665 25110 10140 11621 12042 15401 17270 20245 21320 23675 25111 10160 11622 12044 15570 17271 20250 21335 23700 25112 10180 11623 12045 15572 17272 20500 21346 23921 25115 11000 11624 12051 15574 17273 20501 21480 23930 25118 11001 11626 12052 15576 17274 20520 21493 23931 25150 11004 11640 12053 15620 17276 20525 21501 24065 25230 11006 11641 12054 15630 17280 20526 21550 24066 25246 11010 11642 12055 15736 17281 20550 21555 24075 25248 11011 11643 13100 15740 17282 20551 21556 24076 25259 11012 11644 13101 15760 17283 20552 21800 24105 25260 11040 11646 13102 15781 17284 20553 21820 24110 25290 11041 11719 13120 15786 17286 20600 21920 24130 25295 11042 11720 13121 15787 17304 20605 21925 24136 25337 11043 11721 13122 15788 17305 20610 21930 24145 25430 11044 11730 13131 15789 17306 20612 21935 24147 25445 11055 11732 13132 15822 17307 20615 22305 24160 25450 11056 11740 13133 15823 17310 20650 22310 24164 25455 11057 11750 13150 15840 17340 20660 22315 24201 25500 11100 11752 13151 15851 17360 20661 22505 24300 25505 11101 11760 13152 15852 19000 20664 22520 24332 25520 11200 11762 13153 15931 19001 20670 22521 24354 25530 11201 11765 13160 15934 19020 20690 22522 24500 25535 11400 11770 14000 15936 19030 20693 23030 24505 25560 11401 11771 14001 15940 19100 20694 23031 24530 25565 11402 11772 14020 15950 19101 20920 23044 24535 25600 11403 11900 14021 15953 19102 20926 23065 24538 25605 11404 11901 14040 15956 19103 20931 23066 24560 25611 11406 11960 14041 16000 19110 20974 23075 24565 25622 11420 11970 14060 16010 19120 20979 23076 24566 25630 11421 11980 14061 16015 19125 21015 23101 24576 25650 11422 12001 14300 16020 19126 21025 23106 24577 25652 11423 12002 15000 16025 19140 21026 23130 24582 25671 11424 12004 15050 16030 19290 21030 23140 24600 25931 11426 12005 15100 16035 19328 21031 23170 24605 26010
CPT/HCPCS CPT/HCPCS CPT/HCPCS CPT/HCPCS CPT/HCPCS CPT/HCPCS CPT/HCPCS CPT/HCPCS CPT/HCPCS 26011 26665 27266 27707 28112 28496 29740 31090 31633 26020 26676 27275 27730 28116 28505 29805 31200 31635 26034 26685 27301 27732 28119 28510 29806 31201 31636 26040 26700 27323 27734 28120 28515 29807 31231 31637 26045 26706 27324 27750 28124 28531 29819 31233 31638 26055 26720 27327 27752 28126 28606 29830 31235 31640 26070 26725 27328 27760 28140 28636 29848 31237 31641 26075 26727 27330 27762 28150 28645 29870 31254 31643 26080 26735 27340 27766 28153 28660 29871 31255 31645 26110 26740 27370 27780 28160 28666 29873 31256 31646 26115 26742 27425 27781 28173 28675 29876 31267 31717 26116 26746 27437 27784 28175 28755 29882 31276 31720 26117 26750 27475 27786 28190 28820 29886 31500 31725 26121 26755 27477 27788 28192 28825 30020 31502 31730 26123 26765 27485 27792 28193 29065 30100 31505 32000 26125 26770 27496 27808 28200 29075 30110 31511 32002 26130 26775 27500 27810 28208 29085 30115 31515 32005 26140 26776 27502 27816 28220 29086 30117 31525 32019 26145 26785 27508 27818 28222 29105 30120 31526 32020 26160 26860 27510 27824 28225 29125 30124 31530 32400 26205 26861 27516 27840 28226 29126 30130 31535 32405 26210 26910 27520 27842 28230 29130 30140 31536 32420 26215 26951 27530 27884 28232 29131 30150 31540 32960 26236 26952 27532 27886 28234 29200 30200 31541 32997 26320 26989 27560 27889 28240 29220 30210 31545 33010 26340 26990 27570 28001 28270 29240 30220 31546 33015 26350 27000 27594 28002 28272 29260 30300 31570 33200 26356 27040 27596 28003 28285 29280 30420 31571 33201 26410 27041 27600 28005 28286 29345 30520 31575 33206 26416 27047 27601 28008 28288 29355 30560 31576 33207 26418 27060 27603 28010 28290 29358 30580 31579 33208 26426 27062 27606 28011 28310 29365 30620 31582 33210 26432 27093 27607 28020 28312 29405 30801 31600 33211 26433 27095 27610 28022 28313 29425 30802 31603 33212 26437 27096 27613 28024 28315 29435 30901 31605 33213 26440 27185 27614 28035 28340 29440 30903 31610 33215 26442 27193 27618 28043 28341 29445 30905 31613 33216 26445 27200 27619 28046 28344 29450 30906 31614 33217 26460 27220 27630 28050 28400 29505 30915 31615 33218 26476 27222 27635 28052 28430 29515 30920 31620 33220 26477 27230 27640 28060 28436 29530 30930 31622 33222 26520 27232 27641 28062 28450 29540 31000 31623 33224 26525 27235 27652 28070 28456 29550 31020 31624 33225 26535 27238 27680 28072 28465 29580 31030 31625 33226 26593 27240 27681 28090 28470 29590 31032 31628 33233 26600 27246 27686 28092 28475 29700 31040 31629 33234 26605 27250 27695 28108 28485 29705 31050 31630 33235 26615 27252 27696 28110 28490 29720 31051 31631 33240 26650 27265 27704 28111 28495 29730 31070 31632 33244
CPT/HCPCS CPT/HCPCS CPT/HCPCS CPT/HCPCS CPT/HCPCS CPT/HCPCS CPT/HCPCS CPT/HCPCS CPT/HCPCS 33249 36430 37609 42104 43258 45317 46257 49080 51741 33282 36455 37620 42106 43260 45320 46260 49081 51741 33284 36470 37650 42107 43261 45321 46261 49085 51784 33420 36471 37700 42140 43262 45327 46262 49180 51784 33968 36475 37720 42145 43263 45330 46270 49250 51784 33971 36476 37730 42300 43264 45331 46275 49400 52000 33974 36478 37765 42330 43265 45332 46280 49419 52001 34471 36479 37766 42335 43267 45333 46285 49420 52005</