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.