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Physician Regulatory Issues Team (PRIT)

Past PRIT Issues

  Details for Appropriate Reimbursement for Complex Surgeries
  

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Issue Name Appropriate Reimbursement for Complex Surgeries
Issue The Coalition for the Advancement of Prosthetic Urology at the San Antonio American Urology Association meeting asked how a surgeon could get paid more when, because of a preexisting condition or surgery, the procedure took far longer then it normally would.
Status See below.
Date Issue Created 12/01/2004

We are interested in resolving this issue because if physicians cannot be appropriately compensated they will be less likely to want to provide services to these more complex patients.

June 13: Carriers have accepted the 22 modifier as appropriate for these situations. We're talking to providers about examples when this approach has not been effective.

June 17: We have begun a dialogue with the American College of Surgeons and we are looking forward to their input. 


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Last Modified Date : 05/03/2006
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