My private practice outpatient only internal medicine clinic needs to hire a physician extender in the Detroit Michigan area. Review of billing guidelines suggest that without physician direct supervision they both get reimbursed at 85% but a Physician assistant can see new medicare patients and does not seem to have the stringent limitations placed upon CNPs ie new conditions etc. I checked with an Aetna representative who claims Aetna does not accept billing from physician assistants. Does anyone have any advice regarding whether it is better to hire an equally qualified CNP or a PA when billing insurances in Detroit area Michigan.