UNITEDHEALTHCARE: Assistant at Surgery Services Policy

Effective September 1st, 2021

• The policy has been revised to clarify the UnitedHealthcare Medicare Advantage standard reimbursement for assistant-at-surgery services provided by a Health Care Professional other than a Physician (i.e., Physician Assistants (PA), Nurse Practitioners (NP), or Clinical Nurse Specialists (CNS). 
• In accordance with CMS guidelines, UnitedHealthcare Medicare Advantage covered PA assistant-at-surgery services are reimbursed at 80 percent of the lesser of the actual charge or 85 percent of what a physician is paid under the Medicare Physician Fee Schedule. Since physicians are paid at 16 percent of the surgical payment amount under the Medicare Physician Fee Schedule for assistant-at-surgery services, the actual payment amount that PAs receive for assistant-at-surgery services is 13.6 percent of the amount paid to physicians.

Source:https://www.uhcprovider.com/content/dam/provider/docs/public/policies/medadv-reimbursement/rpub/UHC-MEDADV-RPUB-SEP-2021.pdf