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Its a little more complicated than that. Generally if assist is part of the job it doesn't add to the salary. Instead if you don't assist and they have to find another assist the salary is less. This is why a lot of academic surgery jobs pay less (residents do the assist).
Generally for surgery there are three parts to the job.
1. Consults and preop work. The consults are reimbursed but preop work in usually bundled into the surgery fee. Whether some of that income is credited to the APP depends.
2. Assist at surgery. For Medicare the assist fee for APPs is 14.5% (85% of the 16% physician assist fee). Medicaid and other insurances will pay less or more. Then you have to determine if the surgery reimburses a first assist fee.
The neurosurgery codes start around 60000. If they do a lot of spinal simulators then there isn't any first assist reimbursement. On the other hand if they do a lot of spine surgery there is.
3. Follow up inpatient and in the office. This is again usually bundled into the global surgery fee. However, if the APP is doing this work, it frees up the physician to do more consults or surgeries that don't require an assist.
As for the money, here's how it works.
For example CPT 63001 for a lumbar laminectomy (there are many codes for this depending on what else is going on but I chose this for demonstration).
The work RVU (RVU for physician work) for this is 17.61 wRVUs for the surgeon. Medicare reimburses around $31 per RVU. So the surgeons fee would be $545. The assist fee would be $79. As you can see here the assist fee would barely cover the salaries + benefits. On the other hand a multi level lumbar laminectomy with hardware will have a surgeons fee over $8000 and the assist fee will be over $1000.
So fundamentally it does't really add to your income although it should be baked into the salary. Now some practices will reward APPs for being more productive ie. Extra money for RVUs over a certain amount. Another way is to reward call and late hours. For example one practice gives the APPs 100% of the RVUs when on call or after 5pm.
On the other hand if you have to take call and an uninsured patient comes in you are working for free. Also remember the average neurosurgery hours are around 55-60 hours per week. Lots of call and late nights. There is a reason neurosurgery salaries are high.

I would disagree. While a surgeon will hire an NP or a PA for what they do outside the OR, the ability to bill is key. The issue is that surgical reimbursement revolves for the most part around the operation. If you do a Liver transplant (for example) with Medicare as the Payor,the surgeon will receive around $20k for the surgery and all of the follow up care for the next 90 days. If they use an RNFA they will receive no other reimbursement and the RNFA will not be able to participate in follow up care in a way that meets Medicare documentation requirements. On the other hand if a PA or NP first assists they will receive 13.6% of the surgeons fee (85% of 16%). So they will bring in around $2700 dollars to help support their salary as they do follow up care for the patient. In addition they can round in the hospital, order and interpret labs and test as well as D/C the patient. All of which frees up the surgeon to do other things.
In a Medicare environment it absolutely makes no sense to use anyone but an NP, PA or CNS (where allowed). Other insurers make reimburse other first assistants such as CFAs and RNFAs. So it might make sense to use them there. However this ignores the real value of of an NP or PA. The AAPA has a very nice study that they use in their billing course. It was done by a national consulting firm and looks at the revenue generate by PAs in orthopedics. On the average they generated $302,000 for the practice (2002 dollars). One third was first assist fees. One third was office procedures and visits. The final one third was increased physician productivity enabled by the PAs doing unbillable care (post of follow ups). This allowed the physician to see more consults and schedule more surgeries. This is something that only an NPP can do.
David Carpenter, PA-C