Medicaid Expansion of Coverage for Surgical First Assistants

Date Issued: 11/30/2016

Effective December 1, 2016, New York State Medicaid Managed Care will recognize Registered Nurse First Assistants (RNFAs) and provide additional surgical assist reimbursement when appropriate.

An RNFA is a registered professional nurse who is certified in operating room nursing. The RNFA provides supportive and restorative patient care by performing as a first assistant at surgery under the direction of a licensed physician in accordance with scope of practice qualifications.

Per the Centers for Medicare & Medicaid Services’ guidelines, physicians seeking to claim reimbursement that includes RNFA services must first verify that the procedure being performed allows for a nonphysician surgical assistant.

Claims for services that meet the above criteria should be billed by appending the “AS” modifier to the appropriate procedure code. Reimbursement for approved services will be made to the physician.

For additional information, please refer to these additional billing instructions from the eMedNY website.