CMS Pub. 100-04, ch. 4, § 250.9.2

Method II CAH

(Rev. 1620; Issued: 10-24-08; Effective: 01-01-08; Implementation: 04-06-09)

Under Section 1834(g)(2)(B) of the Social Security Act (the Act) outpatient professional

services performed in a Method II CAH are paid 115 percent of such amounts as would

otherwise be paid under the Act if the services were not included in the outpatient CAH

services.

Section 1848(i)(2)(B) of the Act stipulates that in the case of a surgical service furnished

by a physician, if payment is made separately under the Act for the services of a

physician serving as an assistant at surgery, payment shall not exceed 16 percent of the

MPFS amount.

Payment for assistant at surgery services performed by a physician is calculated as

follows:

• ((facility specific MPFS amount times assistant at surgery reduction % (16%))

minus (deductible and coinsurance)) times 115%

Section 1833(a)(1)(O)(ii) of the Act states that in the case of a PA, NP or CNS the

amounts paid for serving as an assistant at surgery shall be the lesser of the actual charge

or 85 percent of the amount that would otherwise be recognized if performed by a

physician who is serving as an assistant at surgery. The payment methodology for these

services has been codified in regulations found at 42 CFR 414.52(d) and 414.56(c).

Payment for assistant at surgery services performed by a PA, NP, or CNS is calculated as

follows:

((facility specific MPFS) amount times assistant at surgery reduction (16%) times non-physician practitioner reduction % (85%)) minus (deductible and coinsurance))

times 115%