Billing for Physician Assistant

[Texascoder64]

Need some input on services performed by a P.A. I know the "incident to" rules" which apply to Medicare patients only. But need specific input on billing commercial carriers for office services performed by a P.A. Does the P.A.'s NPI have to show on the claim? If you bill the P.A.'s services with only the M.D.s info on the claim, (like we do for incident to) would an audit result in misrepresenting the service?

[mmpratt]

Our PAs are also credentialed with our payers. Does your documentation specify a supervising physician? If it does not, then it should be billed under the PA's NPI with the PA showing as the provider.

[Texascoder64]

The visit documentation has a "standard" note that Dr X is the supervising physician.
Will that suffice for billing under the Dr's. NPI for commercial payers?. This makes it sound like incident to billing which I thought only applied to Medicare. This seems like such a gray area to me. Do not want to assume and have a problem later. Some of the carriers may or may not require credentialing the PA - we bill under a group NPI
Of course we would prefer the 100 % reimbursement but the payers I have spoken to say that if it is billed under the PA then would be 80 - 85% instead.

[Herbie Lorona]

Your best bet is to check with the individual insurances. They may all have there own rules as to how you would bill those. We have a few that don't contract a P.A. so they tell us to bill those under the supervising physicians info. Others tell us if the P.A. sees the patient we bill under the P.A. and don't follow any time of incident to rule.