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Does a PA have to bill medicare directly when they assist on a surgical case?

Valerie Posted Wed 29th of February, 2012 05:44:00 AM

Use of modifier AS to bill for PA assisiting on surgical case with an ENT. Are PA services billed with physician or as a separate claim?

SuperCoder Answered Wed 29th of February, 2012 08:13:55 AM

For the PA, you can bill direct under the PA's NPI number or incident-to, under the MD's NPI number, if the incident-to guidelines are met. If you bill direct, under the PA, Medicare will allow 85% of the fee schedule amount. If you bill incident-to, under the doctor, Medicare will allow 100% of the fee schedule amount. .....

PA assistant-at-surgery services are paid to the employer of the PA by the carrier or A/B MAC at 85 percent of 16 percent of the MPFS.

Torrey Answered Wed 29th of February, 2012 11:31:40 AM

Unfortunately, whether or not to bill them on the same claim form depends on the payer.

For instance, Blue Cross/Blue Shield of MS requires separate claim forms ("Assistant at surgery services should be filed to BCBSMS on a separate claim form from the primary surgeon's services. All services should be filed using the assistant surgeon's BCBSMS provider identification number and the National Provider Identifier number. BCBSMS will not accept modifier -AS for dates of service after January 1, 2010 on the same claim form as the primary surgeon's claim. Any claims with dates of service after January 1, 2010 that contain modifier -AS on the same claim form as the primary surgeon's claim will be rejected/returned to the provider for correction." http://www.bcbsms.com/com/bcbsms/apps/PolicySearch/views/ViewPolicy.php?&blank&action=viewPolicy&noprint=yes&path=%2Fpolicy%2Fecode%2FNurse_PA_as_Surg_Asst.html&keywords=%3C!123-321!%3E&source=ecode&page=q=provider-coding-policy-search.html&me=index.php)

However, Washington Medicaid states "Surgical assistant and/or physician assistant services must be identified
by adding modifier 80 to the usual procedure code(s). A physician assistant, employed by a physician, must use the physician’s provider number and must bill on the same claim form as the physician/surgeon." (http://hrsa.dshs.wa.gov/download/BillingInstructions/Physician-Related_Services_March_2010/Section_L.pdf)

Check with your payer before you bill to ensure that you've billed it accurately.

Torrey Kim, CPC, CGSC
Editor-in-Chief
The Coding Institute

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