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TRICARE Policy Manual 6010.60-M, April 1, 2015
Chapter 4
Section 4.1
Assistant Surgeons
Issue Date:  April 5, 1989
Revision:  
1.0  DESCRIPTION
A physician, dentist, podiatrist, certified physician assistant, certified nurse practitioner, or certified nurse midwife acting within the scope of their license who actively assists the operating surgeon in the performance of a covered surgical service.
2.0  POLICY
2.1  Services of an assistant surgeon are covered when:
2.1.1  The surgical procedure is of the complexity and seriousness as to warrant a surgical assistant (other than the surgical nurse or other such operating room personnel).
2.1.2  Interns, residents or other hospital staff are not available to provide the surgical assistance.
2.1.2.1  The operating surgeon may be required to certify in writing to the non-availability of a qualified intern, resident, or other house physician.
2.1.2.2  In lieu of the operating surgeon’s certification, the contractor may maintain an annually updated list of hospitals that have certified that they do not have internal staff available at any time to perform the services of assistant surgeons.
2.1.3  Review is required to ascertain whether the services of an assistant surgeon are covered when:
2.1.3.1  The surgical assistance occurred in a hospital that has a residency program in a specialty appropriate to the surgery;
2.1.3.2  The surgery was performed by a team of surgeons;
2.1.3.3  There were multiple assistant surgeons; or
2.1.3.4  The assistant surgeon is in partnership or practice with the primary surgeon.
2.2  Assistant surgeons used for Percutaneous Transluminal Coronary Angioplasty (PTCA) or Percutaneous Transluminal Coronary Arthrectomy may be covered if criterion in paragraph 2.1.2 is met.
3.0  EXCLUSION
Standby assistant surgeons.
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