18 Del. Admin. Code § 1312-5.0

Current through Register Vol. 28, No. 5, November 1, 2024

Section 1312-5.0 - Guidelines for payment for the services of assistants at surgery

5.1 A health insurer shall be required to make payment for the professional services of assistants at surgery. Such payment shall be made in the same manner set as forth in the Balanced Budget Act of 1997 and applicable publications issued by the Health Care Financing Administration (HCFA), including but not limited to HCFA's regulations, the Medicare Part B Physician/Supplier Handbook, and Medicare Part B newsletters.

5.2 Medicare rules governing the following aspects of claims for services of assistants at surgery shall be observed:

5.2.1 the percentage of fee schedule (as "fee schedule" is defined herein) for physicians acting as assistants at surgery;

5.2.2 the percentage of fee schedule (as "fee schedule" is defined herein) for non physicians acting as assistants at surgery; and

5.2.3 whether the surgical procedure in question is eligible for assistant at surgery services.

18 Del. Admin. Code § 1312-5.0