Surgical assistance patient claim processing in Medicare 011-43010160

Service Officers should follow return messages as they display. If unsure of the procedure, contact Local Peer Support (LPS).

Assistant practitioners must bill the appropriate item based on the:

• assistance provided, and/or
• schedule fee amount for the operation where assistance was provided

Note: an assistant can be used during any procedure, however assistant item numbers are eligible for Medicare benefits only where the associated surgical item descriptors are endorsed with the word ‘Assist’. The main operating surgeon and assistant cannot be the same health professional.

Assisting one surgeon

A main operating surgeon may engage the services of an assistant for a period of time during a procedure on a patient.

The main surgeon may include the fees for the assistant on their own account. The payment of the assistant's fees is then made by the main surgeon to the assistant.

Alternatively, an assistant practitioner can bill the patient separately.

Assisting 2 surgeons

When a practitioner assists 2 surgeons performing separate surgeries during one anaesthetic, the items for all 3 practitioners must be assessed separately. Billing the patient for the assistant fee may be done by either or both surgeons. The payment of the fees is then made directly to the assistant by either or both surgeons.

Alternatively, the 2 surgeons and assistant may bill the patient separately.

Note: where a patient is issued an unpaid account/invoice, the Medicare benefit will be paid as it appears on the account/invoice.