Assistant surgeon accounts processing in Medicare 011-43010160

Service Officers should follow the on screen and PF1 help messages. If unsure of the procedure, processing assistance should be sought from the supervisor, Local Peer Support (LPS) or Service Support Officer Assessing and Benefits.

When a surgeon assists in an operation they bill the patients using an 'assistant surgeon' item number. This policy outlines the options for billing patients, where a surgeon assists with a procedure.

Note: an assistant surgeon 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 surgeon cannot be the same health professional.

Assistant surgeons must bill the appropriate assistant surgeon item based on the assistance provided and/or the schedule fee amount for the operation at which assistance was provided.

Assisting one surgeon

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

The main operating surgeon may include the fees for the assistant surgeon on their own account. The payment of the assistant's fees is then made by the main operating surgeon to the assistant surgeon, and is not the responsibility of the patient.

Alternatively, an assistant surgeon will work as an individual surgeon and bill the patient separately.

Assisting two surgeons

When an assistant surgeon is required to assist two surgeons performing separate surgeries during one anaesthetic, the items for all three providers must be assessed separately. Billing the patient for the assistant surgeon's 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 two surgeons and assistant surgeon may work as individuals and 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.