We've recently begun to receive Medicare denials on claims submitted by PAs and NPs for CPT 61108. The denial states “This provider type/provider specialty may not bill this service”. This has never been an issue until this calendar year. We changed MACs from Cahaba to Palmetto effective Feb 26 but some dates of service are prior to that change. I've not been able to find anything on this and was curious if anyone else was having this issue.
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mitchellde
True Blue
You may need to check with the board that grants licensure to your PAs and NPs. They will be the ones most likely that have set this. if they do not allow this procedure to be performed by PAs and NPs then one of two things may have occurred:
1... It has always been that way and you were paid in error in the past
2... your state made a change and the payer is following accordingly.
It may also be that the payer made a policy change although I would tend to doubt this but you should check with the carrier to see if they have imposed restrictions on PA and NP allowable services.
1... It has always been that way and you were paid in error in the past
2... your state made a change and the payer is following accordingly.
It may also be that the payer made a policy change although I would tend to doubt this but you should check with the carrier to see if they have imposed restrictions on PA and NP allowable services.