Reimbursement for Assistant-at-Surgery services, when reported by the Same Individual Physician or Other Qualified Health Care Professional, is based on whether the Assistant-at-Surgery is a Physician (designated by modifiers 80, 81 We will do our best to work with you and your plan. CPCP020. Access to Aetna's team of clinicians. Staged or Related Procedure or Service by the Same Physician or Other Qualified Health Care Professional During the Form approved 03/06/2020 by John Hay, DMS. For Health Care Providers | Aetna Medicaid New Jersey For Appointments: Please select your preferred provider criteria above and click List Doctors tab. services which are reimbursable services are set forth on UnitedHealthcare's Assistant-at-Surgery Eligible List. 1-866-874-0633 Log on to: pshp.com January 2020. UNC Health Provider. Dr. Derek Ray Serna-Gallegos, MD - Pittsburgh, PA ... Our health plan is a subsidiary of Aetna, which has more than 150 years of experience in . The Plan primarily determines whether codes are eligible/billable for assistant surgeons based on the "Assistant Surgeon" indicator in the current CMS National Physician Fee Schedule (LINK) as follows: Surgical Assistant 10-027 - Florida Blue Changes to the National Precertification List (NPL) 48.22.808.1-Q2-MA (3/13) www.aetna.com Aetna OfficeLink Updates TM Health Insurance Exchanges are coming - learn more about them . Doctor page - Rutgers University If you don't see your plan or you have questions, please call our Customer Service Center at 877-938-7497. Suite 400 . Aetna is the brand name used for products and services provided by one or more of the Aetna group of companies, including Aetna Life Insurance Company and its affiliates (Aetna). Thank you for participating in our network of participating physicians, hospitals, and other healthcare professionals. Select View Archive. Member Eligibility Search - DentaQuest Round the clock support for you and your family. The Assistant Surgeon Eligible List is developed based on the Centers for Medicare and Medicaid Services (CMS) National Physician Fee Schedule Relative Value File (NPFS) status indicators. Vascular Surgery, General Surgery. This includes teeth cleaning, x-rays, cavity fillings, crowns and other services. Should be submitted on those surgical procedures where an assistant surgeon is warranted. PDF Volume 10, Issue 1 Aetna OfficeLink Updates For Appointments: Please select your preferred provider criteria above and click List Doctors tab. Assistant Surgeon Modifiers Modifier 80, 81, 82: Denote assistant surgeons. Provider Manual - Aetna Doctor page • To bill for these services, providers should use modifier 80 (assistant surgeon), 81 (minimum assistant surgeon), or 82 (when qualified resident surgeon not available). 1, 10-01-03) B3-15044 state: For assistant at surgery services performed by physicians, the fee schedule amount equals 16 percent of the amount otherwise applicable for the global surgery. • Bilateral assistant surgeons are reimbursed at 16% of the allowable 150% amount. R 12/20.4.3/Assistant-at-Surgery Services R 12/110/Physician Assistant (PA) Services Payment Methodology N 12/110.1/Global Surgical Payments R 12/110.2/Limitations for Assistant-at-Surgery Services Furnished by Physician Assistants R 12/110.3/Outpatient Mental Health Treatment Limitation R 12/110.4/PA Billing to the Contractor . Welcome to Peach State Health Plan. Product Name: Aetna Open Access Plans — Aetna Choice POS II network. R 12/20.4.3/Assistant-at-Surgery Services R 12/110/Physician Assistant (PA) Services Payment Methodology N 12/110.1/Global Surgical Payments R 12/110.2/Limitations for Assistant-at-Surgery Services Furnished by Physician Assistants R 12/110.3/Outpatient Mental Health Treatment Limitation R 12/110.4/PA Billing to the Contractor . They are based on objective, credible sources, such as the scientific literature, guidelines, consensus statements and expert opinions. On or before January 1, 2020, some Indiana Medicaid providers will begin to use a system called Electronic Visit Verification. +1 (844) 619-3678 Jan 15, 2020. He is an assistant professor in the Department of Plastic Surgery and is an adjunct professor at the University of Pittsburgh School of Public Health . The list of providers that matches your selected criteria will be listed on the left margin of the page. UnitedHealthcare Community Plan's standard reimbursement for Assistant-at-Surgery services on the Assistant-at- Surgery Eligible List which are provided by a Physician is 16% of the Allowable Amount for eligible surgical procedures. assistant-at-surgery services are provided by a physician. Aetna PO Box 981106 El Paso, TX 79998-1106 For all Medicare and Aetna Student Health℠ plans, use the El Paso, TX, claims mailing address. • Providers should also use modifier AS to indicate that a PA, NP or CNS served as the assistant at surgery. Assistant Professor. CCI and OCE_CCI v26.0 Addition and . Adults enrolled in MA are eligible at a minimum for surgical procedures and emergency . Eligibility for P4HB Program . You'll find most of the information you need in the provider manual.You'll learn which services our plan covers. Brodie Parent, MD, MS, is a reconstructive plastic and general surgeon, who is board-certified by the American Board of Surgery, and is board-eligible in the American Board of Plastic Surgery. DMAS_0921-PM-300103 Get International Health Insurance. Our Clinical Policy Bulletins (CPBs) explain the medical, dental and pharmacy services we may or may not cover. Expanded claims edits* The services described in Oxford policies are subject to the terms, conditions and limitations of the Member's contract or certificate. PDF Summary Comparison of Health Plans for Employees PDF A quick reference guide for health care professionals Assistant Professor. LMC - Lexington Medical Center. Benefits will be derived based on CMS designation for Assistant Surgeon. Aetna Clinical Policy Bulletins. An "assistant at surgery" is a physician who actively assists the physician in charge of a case in performing a surgical procedure. (984) 974-0150. Breast Reconstruction . June 1, 2018, we will make changes to some of the procedures we consider eligible for assistant surgeons and surgical assistants for Coventry commercial and participating Medicare claims, in accordance with Aetna's current policy. codes may be processed and to determine eligibility of an assistant surgery procedure - Policy Information — to find policy-related links if for assistant at surgery services. When billed without modifier AS (PA, NP or CNS services for assistant at surgery) the use of these modifiers indicates that a physician served as the assistant at surgery. Assistant Surgeon Eligible List. Correct Use. The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) mandated that CMS collect data on the number and level of post-operative visits to . Mastectomy . Aetna Student Health offers Aetna's broad network of In-network Providers. (984) 974-0150. This guide explains how to work with us. 58 . National Drug Code Payment Policy. Retired 12/31/2021. The operative note should clearly document the assistant surgeon's role during the operative session. • Providers should also use modifier AS to indicate that a PA, NP or CNS served as the assistant at surgery. Restrictions . Gastrointestinal Surgery, General Surgery, Weight-Loss Surgery. Submit Claims to: Aetna Inc P.O. Frequency . Enroll as a provider with the IHCP to bring critical medical care to eligible Hoosier children and adults. The ACS Study has three designations to indicate whether the operation requires the use of an assistant at surgery: (1) Box 14089 Lexington, KY 40512-4089. multiple procedure guidelines, as well as being eligible for assistant surgeon services, benefits for those services will be allowed and processed according to the multiple procedure guidelines. Aetna Customer Service Phone (Aetna One Advisor): 800-843-9126. 100% of eligible charges subject to plan copayments. Below is a high-level summary of some of the changes, including updated code auditing rules related to existing codes, as well as the January 1, 2020 code release of CPT® and HCPCS. • To bill for these services, providers should use modifier 80 (assistant surgeon), 81 (minimum assistant surgeon), or 82 (when qualified resident surgeon not available). Audits Involving Medicare Demand Billing and Overpayments Involving Dual Eligible Recipients. Information is current as of: 11/6/2020 3:13:00 PM For latest information, call: 1. 1.8 07/17/2020 Vicky Hicks Mary Larson Updated Provider Representative List extensions. As an Aetna ® provider, there are certain procedures and protocols you need to know. Jacob Wood, MD. Use the Eligibility and Benefits inquiry to obtain member- . for assistant at surgery services. For all Aetna Voluntary plans and limited benefits insurance plans (formerly "Aetna Affordable HealthChoices℠ plans"), use the Lexington, KY, claims mailing address. If you believe that you have received this message in error, please contact your health plan representative. #Aetna. Jobs View All Jobs Medigap). A simple way to pay your premiums online. 2020/06/25. welfare and those retirees not eligible for medicare fund rates as of july 2020. subject to change. Select Audiology Services . Prior Authorization . You'll also find information about a wide variety of topics, ranging from provider responsibilities, to how to file a claim, to grievance and appeals processes. #Insurance. Chesapeake, VA 23320 . 2020/11/18. Leidos Group Number: 698685, 868856. NOTE: Physicians acting as assistants cannot bill as co-surgeons. We have over 30 years of experience serving Medicaid populations, including children, adults and people with disabilities or other serious health conditions. It is from Aetna insurance. Assistant Surgeon . Surgical procedures eligible for assistant surgeon performed by RNFAs must be billed using the primary surgeon's provider number, including . Such care is usually provided when: Hand Surgery - Eligible Orthopaedic Surgery - American Board of Orthopaedic Surgery, 2018 . If your session timed out, Login. Assistant Surgeon is a Physician (designated by modifiers 80, 81 or 82) or another Health Care Professional (designated by modifier AS) acting as the surgical assistant. Oxford reserves the right, in its sole discretion, to modify policies as necessary without . with a list of eligible practitioners along with their individual and group NPI numbers for use for the coming Fiscal Year. Derek Serna-Gallegos, MD, is a cardiac surgeon and is certified in general surgery by the American Board of Surgery and is board eligible for board certification in cardiothoracic surgery by the American Board of Thoracic Surgery. Specialties. Supervision of Physician Assistant, Advanced Practice Nurse… processed and to determine eligibility of an assistant surgery procedure . 57 . This number is using AETNA Health insurance company name. This information is a guide only; there may be circumstances where an assistant surgeon is necessary due to complications or unusual circumstances. Modifier 80 is appended to the surgical code when another surgeon is assisting at surgery. If a Co-Surgeon acts as an Assistant Surgeon in the performance of additional procedure(s) during the same surgical session, the procedures are reimbursable services (if eligible per the Assistant Surgeon Eligible List) when indicated by separate procedure code(s) with modifier 80 or modifier 82 added, as appropriate. Be Aware of Limitations. Access to Aetna's team of clinicians. . Eligibility Criteria . Get International Health Insurance. Florida Blue uses the American College of Surgeons' (ACS) 2020 Study as the primary source to determine whether a procedure is eligible for reimbursement for an assistant-at-surgery. When a surgeon is unexpectedly requested to render services during an ongoing operative session, claims will Aetna is the brand name used for products and services provided by one or more of the Aetna group of subsidiary companies, including Aetna Life Insurance Company and its affiliates (Aetna). Non-physician providers assisting with surgery should append modifier AS. • Use PA's NPI as rendering provider for the first assist. Precertification You need pre-approval from us for some eligible health services. Link to PDF. CMS' Guidelines 20.4.3—Assistant at Surgery Services (Rev. 7 . Instructions. The eligible group NPI number s for the MCO contract year beginning July 1, 2020 is contained in Appendix B. • Reimbursement 13.6% of primary surgeon's allowable fee. Medica Health Plans. He is an assistant professor of surgery at the University of Pittsburgh School of Medicine. Unless otherwise stated, Oxford policies do not apply to Medicare Advantage enrollees. UNC Health Provider. The pilot part of this new process will begin July 1, 2019, so you may see your provider use the new system soon. Breast Surgery . Bariatric Surgery . Pre-trip guidance to help with your next move. 24/7 assistance via toll-phone, fax or email. . Richmond, VA 23219 . Reimbursement . 80% of approved amount after $185 Medicare deductible. You can save money by seeing In-network Providers because Aetna has negotiated special rates with them, and because the Plan's benefits are better. Physician: Assist-at-surgery allowed with appended modifiers 80, 81 . The dental services you may get are based on your eligibility category, age and need. (984) 974-0150. Bristol Office 105 Village Circle . The tool also allows you to enter specific criteria including diagnosis codes . 2020/12/01. Key. Maternity Claims Adjusted Procedures. Biosimilar Preferred Product Update. UNC Health providers are employed by an organization within UNC Health. 1.9 01/06/2021 Vicky Hicks Mary Larson Updated the Cash Refund Documentation form. Call to Schedule. CPCP020. This policy applies to professional providers. Roanoke Office 5060 Valley View . Specialties. No exceptions to this policy are made for teaching . 2020 . Average Aetna, a CVS Health Company hourly pay ranges from approximately $11.98 per hour for Customer Service/Data Entry to $36.84 per hour for Quality Assurance Analyst. Assistant Surgeon. The clinical payment and coding guidelines are not intended to provide billing or coding advice but to serve as a reference . The average Aetna, a CVS Health Company salary ranges from approximately $31,585 per year for Senior Pharmacy Technician to $172,811 per year for Vice President of Operations. 11/06/2021. See Column A indicates if assistant at surgery allowed/not allowed. For Hoosier Care Connect eligibility information, refer to the Eligibility Guide. Starting . codes may be processed and to determine eligibility of an assistant surgery procedure - Policy Information — to find policy-related links if This percentage is based on CMS. ©2020 Aetna Inc. Boulevard NW Roanoke, VA 23012 . 2020/06/12. Assistant at Surgery Modifiers Require Specific Documentation. Job Description Phonenumtracker.com . Modifier 80 (assistant surgeon), 81 (minimum assistant surgeon), or 82 (when qualified resident surgeon not available) is used to bill for assistant at surgery services. ©WellCare 2020. Assistant at surgery modifier fact sheet. For individuals and families. All codes in the NPFS with the following status code indicator "2" for "Assistant Surgeons" are considered by Oxford to When a bilateral procedure code and surgical procedure(s) are performed at the same session and eligible for multiple procedure reduction, claim will be subject . Reduction . Reimbursement Policy: Assistant at Surgery Effective Date: February 1, 2008 Revision Date: November 30, 2015 Purpose: Provide guidelines for the reimbursement and eligibility of Assistant at Surgery modifiers. 2020/06/12. Check Medicare Physician Fee Schedule (MPFS) Indicator/Descriptor Lists. Reimbursement Policies. UNC Health providers are employed by an organization within UNC Health. In our Assistant Surgery Services Coding Chart dated June 15, 2018, we are adding procedure codes 15733, 19294, 20939, 31241, 31253, 31257, 31259, 31298, 36465, 36466, 36482, 36483, 38222, 55874, 0479T, 0483T, 0484T, C9738, C9748, G0516, G0517, G0518, (effective January 1, 2018 . Milliman Care Guidelines (MCG)) and the CMS Provider Reimbursement Manual. Additional sources are used and can be provided upon request. Aetna is one of the nation's premier healthcare benefits companies and has repeatedly been named to the Most Admired Companies list compiled by Fortune magazine.Aetna employs nearly 50,000 professionals and has previously offered part-time, occasional, flexible schedule, hybrid remote, and . Information is current as of: 11/6/2020 3:13:00 PM For latest information, call: 1. Office Manual for Health Care Professionals (applies to all regions) Link to PDF. Reimbursement for Assistant-at-Surgery services, when reported by the Same Individual Physician or Other Qualified Health Care Professional, is based on whether the As sistant Surgeon is a Physician (designated by modifiers 80, 81 or 82) or another Health Care Professional (designated by modifier AS) acting as the surgical assistant. Pre-trip guidance to help with your next move. (984) 974-0150. 07/01/2020 Code list update 01/01/2020 Code list update 01/01/2019 Code list update 01/01/2018 Code list update 08/17/2017 Annual policy review #Aetna. The services of only one Assistant Surgeon are reimbursable for each procedure on the Assistant Surgeon Eligible List. The AlaskaCare Retiree health plan was created by statute to provide health coverage to eligible retirees and their dependents in 1975. Over my almost 30-year surgical coding career, the documentation for assistant surgeons consisted of only the name of the assistant surgeon in the operative note header. Accepting New Patients. Office Manual for Health Care Professionals. including surgeon's and assistant surgeon's fees. Provider Manual — State Supplement. Clinical payment and coding policies are based on criteria developed by specialized professional societies, national guidelines (e.g. Audiologist Employed by Hospitals . 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