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Maarit Posted Mon 05th of March, 2012 17:34:47 PM

May a P.A charge consult codes when another provider has referred a PT for a derm consult...or are consult codes to be used by MDs only?

SuperCoder Answered Mon 05th of March, 2012 20:03:05 PM

The services should be billed under the supervising physician's NPI number for 100 percent reimbursement of the physician's fee schedule. When the ordering physician (the physician who originally saw the patient and outlined a treatment plan) is not the same as the supervising physician (the physician who was in the office the day of the visit), CMS 100-4, Transmittal 148 clarified that it is acceptable for another physician in the same group to provide direct supervision and bill Medicare for the service when the ordering physician is not present in the office.

A nurse practitioner or a physician assistant can also serve as an ordering or supervising provider. However, payments for services provided will be limited by Medicare to 85 percent of the physician fee schedule. If you are billing under the nurse practitioner or physician assistants' NPI number, services provided by other medical staff can be billed incident to the NPP services.

When billing, make sure the proper physician's name appears on the claim.

Maarit Posted Wed 07th of March, 2012 01:31:33 AM

Thank you, Amit.
My question is not really about "how to" bill for P.A, but may we use consult codes 99241- 99245 for a P.A? Is there any regulation that says only medical doctors may act as consultants? CPT book uses the term 'physician" when defining the use of consult codes.
I appreciate more help on this.

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