NC Tracks(NC Medicaid) and assistant to surgery Modifier denial

Coastal Coder

Roanoke, VA
Best answers
Good Morning,

Just wondering if anyone else is having trouble getting paid for assistant to surgery for PA's. We are filing with CPT code 37225- 80. Medicare is paying as primary and then medicaid denies stating CPT/modifier combo is invalid. When the AR girls call NC Tracks all they will tell them is that its wrong and will not advice the proper modifier.

We are filing to medicare primary with the PA's name and modifier AS per their guidelines and then the crossover is being denied. When they go in and change to the DR name and use the 80 it is still being denied.

Any help with this would be greatly appreciated, we have tried everything and have a bunch of these just sitting on the AR.

THanks so much in advance,


Best answers
If the assistant is a PA - use modifier AS. Then it will depend on the payer's requirement on billing for the PA.

When we had a PA start in the group, we had to contact all of our various payers to verify if we can add him to our group contract & then how they will require us to bill our claims for the PA.

Some payers allowed us to add him to our group contract & then if so we were expected to bill under the PA's name.
Some payers allowed us to add/tie him to our group contract but instructed us to report the billing provider as the supervising physician & then just report the PA as the servicing.

What I would do is contact the payer you are getting the denials on & specifically ask them if the PA is showing as contracted/credentialed with them.
If so, ask them if the PA is tied to your group & if so, verify if you can bill under the PA's name.

If the PA isn't contracted/credentialed with them, specifically ask them what steps you should take to take care of that & go from there.

Hope this helps.