First Assist as PA Billing and reimbursements

[sjv2016]

Hello:

Can anyone expand and explain (from real life experiences) how reimbursements and payouts occur. I am PA First Assisting in General Surgery cases. Attached is a medtronic list of reimbursement and fee schedule, which Im also hoping someone can comment on. If they are accurate or completely incorrect, etc?  Here are few specific questions I have:

1. Can you say "in general" what is the typical reimbursement for general surgery cases or just cases in general? Is it 200-400$? In some research I have done, this is what Im discovering. I spoke to a Uro Gyn surgeon recently who told me maybe in rare out of network cases, there are larger payouts, but less than 1% of the time.

2. Do you require cash pay upfront, before surgery with flat fee of $150-350? Do you have them sign consent? Any issues from surgeon with doing this? Complaints from patients?

3. As an example see attached. Gastric Bypass with Roux en y as outpatient shows  CPT 43620 shows $2046. By my calculation if using CMS  $2046 x 16%=327 ; $327x 85%= $278 . Is this about what this case would and does pay out?

4. How does the contract amount your surgeon has with different payers affect payouts? Can someone provide examples.

Thanks in advance to anyone able to help out here. 

 

 

reimbursement-coding-guide-medicare-general-surgery.pdf

Edited April 8, 2022 by sjv2016

[GabrielYakubov]

I would recommend reading the AAPA reimbursement handbook which can be purchased from them.