Forum - Questions & Answers
Reimbursement for Co-surgery
My provider does not participate with commercial insurance companies. He bills as a co-surgeon, when it comes to reimbursement for the procedure. Do we have to follow the co-surgery reimbursement of 62.5% or we can negotiate a higher reimbursement?
reimbursement
If you don't participate, with whom are you negotiating?
Reimbursement for Co-sugery
Third-party vendors acting on the behalf of the insurance company.
reimbursement for co-surgery
It's not clear to me why you negotiate when you don't participate.
CPT provides coding and not reimbursement rules, of course. CMS and other payers set reimbursement policy. CMS's policy is the 62.5% for co-surgery, assuming the surgery has a co-surgery indicator in the fee schedule.
I don't know of any other written justification for another amount.