[Code of Federal Regulations]

[Title 42, Volume 2]

[Revised as of October 1, 2005]

From the U.S. Government Printing Office via GPO Access

[CITE: 42CFR415.190]



[Page 807]

 

                         TITLE 42--PUBLIC HEALTH

 

                    CHAPTER IV--CENTERS FOR MEDICARE

                          & MEDICAID SERVICES,

                        DEPARTMENT OF HEALTH AND

                             HUMAN SERVICES

 

PART 415_SERVICES FURNISHED BY PHYSICIANS IN PROVIDERS, SUPERVISING 

PHYSICIANS IN TEACHING SETTINGS, AND RESIDENTS IN CERTAIN SETTINGS

--Table of Contents

 

            Subpart D_Physician Services in Teaching Settings

 

Sec. 415.190  Conditions of payment: Assistants at surgery in teaching 

hospitals.



    (a) Basis, purpose, and scope. This section describes the conditions 

under which Medicare pays on a fee schedule basis for the services of an 

assistant at surgery in a teaching hospital. This section is based on 

section 1842(b)(7)(D)(I) of the Act and applies only to hospitals with 

an approved GME residency program. Except as specified in paragraph (c) 

of this section, fee schedule payment is not available for assistants at 

surgery in hospitals with--

    (1) A training program relating to the medical specialty required 

for the surgical procedure; and

    (2) A resident in a training program relating to the specialty 

required for the surgery available to serve as an assistant at surgery.

    (b) Definition. Assistant at surgery means a physician who actively 

assists the physician in charge of a case in performing a surgical 

procedure.

    (c) Conditions for payment for assistants at surgery. Payment on a 

fee schedule basis is made for the services of an assistant at surgery 

in a teaching hospital only if the services meet one of the following 

conditions:

    (1) Are required as a result of exceptional medical circumstances.

    (2) Are complex medical procedures performed by a team of 

physicians, each performing a discrete, unique function integral to the 

performance of a complex medical procedure that requires the special 

skills of more than one physician.

    (3) Constitute concurrent medical care relating to a medical 

condition that requires the presence of, and active care by, a physician 

of another specialty during surgery.

    (4) Are medically required and are furnished by a physician who is 

primarily engaged in the field of surgery, and the primary surgeon does 

not use interns and residents in the surgical procedures that the 

surgeon performs (including preoperative and postoperative care).

    (5) Are not related to a surgical procedure for which CMS determines 

that assistants are used less than 5 percent of the time.



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