Assistants at Surgery

Question:

We have surgeons who use their “Fellows” per their program as “Assistants at Surgery” and want to bill the corresponding codes under the “Fellow” with the “80” modifier. Is this OK?  

Answer:

Under the current CMS guidelines, fellows are considered residents when practicing within their GME program, so their services as surgical assistants would not be billable. However, there are certain circumstances where a fellow may bill for their own services when practicing outside their GME program (e.g., in the Emergency Department, seeing patients as a primary physician (not in an orthopedic capacity). A Fellow in a private Fellowship and employed by the group practice is billable as a Fellow. These are non-GME-funded fellowships. 

 In an academic setting, we suggest that questions regarding fellow reporting be referred to Compliance for discussion and direction. CMS has very specific guidelines regarding moonlighting that can be found here: https://www.cms.gov/outreach-and-education/medicare-learning-networkmln/mlnproducts/downloads/teaching-physicians-fact-sheet-icn006437.pdf 

*This response is based on the best information available as of 6/6/24.