"Incident to" billing for Medicaid

aochoa

Networker
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I'm trying to find information on medicaid for billing guidelines on "incident to". Does anybody have a link or know where I can find this information. I need to know if I need to attach a -modifier when billing incident to for a PA.
Thank you
 

TThivierge

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Lithonia, GA
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Hello,

Check the Medicaid web site for information in the state where filing claims and the back of the HCPCS manual in Appendix 2 as guidance. Usually Q6 modifier covers the locums tenens physician in the Medicaid billing situation.

If using Medicare coverage- use the modifier GF for a physician assistant working in conjunction with a MD at a critical care access hospital. If surgery is being done the PA should use modifier AS. In selecting modifiers, always check the setting where medical treatment is being completed and type of service to guide you.

I hope this information helps you:)
 

KMCFADYEN

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Roanoke, VA
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I code in Virginia and for our Medicaid, there is no incident to billing for PA's, only for Medicare (and Aetna, and Coventry). Sometimes there is confusion because in Virginia (not sure of other states) PA's are not credentialed with Medicaid if primary, only for crossover claims from Medicare. We bill the PA under the supervising physicain's NPI which is what is done for incident to billing, hence the confusion.
 

mitchellde

True Blue
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Columbia, MO
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I code in Virginia and for our Medicaid, there is no incident to billing for PA's, only for Medicare (and Aetna, and Coventry). Sometimes there is confusion because in Virginia (not sure of other states) PA's are not credentialed with Medicaid if primary, only for crossover claims from Medicare. We bill the PA under the supervising physicain's NPI which is what is done for incident to billing, hence the confusion.

If the PA is providing the service as incident to and has met all the requirements for incident to, then there is no modifier. The visit is billed using the physician NPI and the PA credentials do not appear on the claim. It is not just billing the PA under the physician NPI, the visit must be incident to, think of it as a follow up visit to a previous visit with the physician for the same diagnosis.
 

aochoa

Networker
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Thank you all for your information, just want to add that is for Texas medicaid.
 
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