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The rules say that plans must pay for a medical service or item if regular Medicare would pay for it in this case. 
You can find this rule at 42 Code of Federal Regulations (CFR) Section 422.101. 
 
The rules say that A/B MACs (B) may not pay assistants-at-surgery for surgical procedures in which a 
physician is used as an assistant-at-surgery in fewer than five percent of the cases for that procedure nationally. 
This is determined through manual reviews. Procedures billed with the assistant-at-surgery physician modifiers 
-80, -81, -82, or the AS modifier for physician assistants, nurse practitioners and clinical nurse specialists, are 
subject to the assistant-at-surgery policy. Accordingly, pay claims for procedures with these modifiers only if 
the services of an assistant-at-surgery are authorized. You can find this information in the Medicare Claims 
Processing Manual Chapter 12 - Physicians/Nonphysician Practitioners, 20.4.3 -Assistant-at Surgery-Services. 
 
The rules say that Assistant at Surgery; this field provides an indicator for services where an assistant at 
surgery is never paid for per IOM. 1 = Statutory payment restriction for assistants at surgery applies to this 
procedure. Assistant at surgery may not be paid. You can find this information in the Medicare Claims 
Processing Manual Chapter 23 - Fee Schedule Administration and Coding Requirements, 50.6 - Physician Fee 
Schedule Payment Policy Indicator File Record Layout. 
 
The rules say that HCPCS code 38525  Biopsy/removal lymph nodes is assigned an Assistant Surgery 
Indicator = 1. You can find this information in the 2022 National Physician Fee Schedule Relative Value File 
January Release. 
 
The rules say that physicians/suppliers must report services correctly. This manual discusses general coding 
principles in Chapter I and principles more relevant to other specific groups of HCPCS/CPT codes in the other 
chapters. There are certain types of improper coding that physicians/supplier must avoid. You can find this 
information in the National Correct Coding Initiative Policy Manual for Medicare Services, Chapter 1 - 
General Correct Coding Policies, Section A. Introduction. 
 
The rules say that an add-on code is a HCPCS/CPT code that describes a service that, with one exception (see 
CR7501 for details), is always performed in conjunction with another primary service. An add-on code with 
one exception is eligible for payment only if it is reported with an appropriate primary procedure performed by the same practitioner. An add-on code with one exception is never eligible for payment if it is the only 
procedure reported by a practitioner. Add-on codes may be identified in three ways: 
1. The code is listed in this CR or subsequent ones as a Type I, Type II, or Type III add-on code. 
2. On the Medicare Physician Fee Schedule Database an add-on code generally has a global surgery period of 
"ZZZ". 
3. In the CPT Manual an add-on code is designated by the symbol "+". The code descriptor of an add-on code 
generally includes phrases such as "each additional" or "(List separately in addition to primary procedure)." 
CMS has divided the add-on codes into three groups to distinguish the payment policy for each group. Type I - 
A Type I add-on code has a limited number of identifiable primary procedure codes. The CR lists the Type I 
add-on codes with their acceptable primary procedure codes. A Type I add-on code, with one exception, is 
eligible for payment if one of the listed primary procedure codes is also eligible for payment to the same 
practitioner for the same patient on the same date of service. Claims processing contractors must adopt edits to 
assure that Type I add-on codes are never paid unless a listed primary procedure code is also paid. Add-On 
Code Edits File for 04012022 Implementation for Medicare 02232022(Effective 01-01-2022 new fixed-width 
text file implemented), Type I  CPT Manual, HCPCS Manual, and/or CMS Policy defines all acceptable 
primary codes: For Add-on code  38900; appropriate Primary Code  38525. You can find this information in 
the CMS.gov, Add-on Code Edits. 
 
The rules say that CPT code 38900 has ZZZ in the Global Days column. You can find this in the 2022 National 
Physician Fee Schedule Relative Value File January Release. 
 
The rules say that Global Surgery - This field provides the postoperative time frames that apply to payment for 
each surgical procedure or another indicator that describes the applicability of the global concept to the service. 
ZZZ = Code related to another service and is always included in the global period of the other service. (Note: 
Physician work is associated with intra-service time and in some instances the post service time.). You can find 
this information in the Medicare Claims Processing Manual, Chapter 23  Fee Schedule Administration and 
Coding Requirements, 50.6 - Physician Fee Schedule Payment Policy Indicator File Record Layout. 
 
If you want to read these Medicare rules, you can go to this website www.medicareappeal.com.