PA billing

baldi18

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When a PA is assisting the doctor in the office on a surgery can the PA bill too?
Thanks
Rachel
 

RebeccaWoodward*

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North Carolina
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There are surgeries that will warrant the use of an assistant...if medically necessary. The modifier will vary from state to state to indicate that it is an assistant. Our region requires modifier AS with the exception of Medicaid. They require modifier 80. There are various sources you can refer to that will indicate whether or not the service is payable for a PA. The physician must dictate the role of the PA to warrant medical necessity. Simply dictating the PA's name won't cut it.
 
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Milwaukee WI
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Teaching Hospital

Additionally, if you are in a teaching facility, the physician must dictate that "No qualified resident was available to assist, so PA Name assisted in this procedure." AND you would use modifier -82.

F Tessa Bartels, CPC, CPC-E/M
 
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Albany, NY
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Determining if an assistant is allowable

This information is available through CMS (on the fee schedule), but UMD was nice to consolidate them into a user-friendly list.

http://www.umd.nycpic.com/08Assistant.html

Medicare pays for an assistant where 95% of surgeons bill for an assistant. That means if less than 5% of surgeons report an assistant for a specific CPT, Medicare won't pay.
 
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