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I am looking for some insight into surgical first assist for an OBGYN private practice. For background information, I am currently paid a relatively low based salary and the remaining of my income comes based off of a percentage of the revenue/collections I bring into the clinic. I am going to start having one OR day first assisting my SP. We are about to discuss compensation, but since I will only be doing 1 OR day (maybe 2), I am wondering if it would be better to set a straight fee per case with my SP or just be paid based off insurance reimbursement. I am new to the OR and have attempted to do some research on the matter, but it has been difficult. Could anyone provide me some insight on payment as a first assist? I am wanting to make it worth my time if I am going to be giving up a clinic day. Thank you!

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  • 2 weeks later...

Ask your billing department --there are THREE possible options 

1. Classic first assistant modifier (AS) billed to surgeons code (where a PA functions as first assist- PA bills at 13.6% of MD surgeon rate --85% of MD FA rate)--advantage is you can clearly track how much you BILL and later BRING IN! 

For example appendectomy- noncomplicated  (CPT code 44950), the facility-only reimbursement is $664, surgeon bills 500-100 based on zip code- you bill $136.

2. "Bundled service" The surgeon is given a 'set fee' for a diagnosis (appendicitis, hysterectomy, etc) and there is no additional payment for a FA --the advantage here is Surgeons w PAs 'do more bundles' lots of data on aapa & aaspa websites 

3. Insurance does not recognize any assistant- no payments, so your arguments would be based on #2 

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