Medicare panel rejects higher fees for nonphysicians, bundling payment

Surgical technologists, advanced-practice nurses and physician assistants see setback in bid for billing autonomy.

By Markian Hawryluk, AMNews staff. May 13, 2002.

Washington -- A congressional advisory panel has opted against expanding Medicare payment for services provided by nonphysician practitioners.

Responding to a congressional request, the Medicare Payment Advisory Commission voted against recommending that surgical technologists be paid directly by Medicare Part B when they serve as first assistants at surgery.

The group also declined to back a proposal to increase payments for advanced-practice nurses and physician assistants.

Under current law, a single surgeon is paid 100% of the surgical fee, and two surgeons operating jointly split evenly 125% of the surgical fee. When a physician serves as a first assistant, Medicare pays that physician 16% of the surgical fee. Physician assistants, nurse practitioners and certified nurse specialists receive 85% of what a physician first assistant would receive. Surgical technologists are not paid by Medicare Part B.

Surgical technologists were not happy with the commission's decision not to allow them to bill Medicare Part B directly. Peter McCambridge, a self-employed surgical technologist who spoke at the commission's recent meeting, said the panel's decision was not financially prudent.

"Each time a physician serves as a first assistant and a surgical technologist does not work in that function, it just costs the program money," McCambridge said. "I'm very disappointed with this decision."

McCambridge hopes Congress will step in and make the change anyway, following the practice of private insurers. "The only insurance company I don't get paid by is Medicare [Part] B." [...]