3. Types of PA Services That May Be Covered
State law or regulation governing a PA's scope of practice in the State in which the services are performed applies. Carriers should consider developing lists of covered services. Also, if authorized under the scope of their State license, PAs may furnish services billed under all levels of CPT evaluation and management codes, and diagnostic tests if furnished under the general supervision of a physician.
Examples of the types of services that PAs may provide include services that traditionally have been reserved to physicians, such as physical examinations, minor surgery, setting casts for simple fractures, interpreting x-rays, and other activities that involve an independent evaluation or treatment of the patient's condition.
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110 - Physician Assistant (PA) Services Payment Methodology
(Rev. 1, 10-01-03)
B3-16001, B3-2156, B3-15004, B3-4112, B3-15024
See the Medicare Benefit Policy Manual, Chapter 15, for coverage policy for physician's assistant (PA) services.
Physician Assistant services are paid at the lesser of the actual charge or 85 percent of the physician fee schedule, except covered PA assistant at surgery services (described below) and services performed in a hospital.
For services performed in a hospital, carriers limit the payment to 75 percent of the fee schedule amount or the lesser of the actual charge for the service. This payment limit applies to a PA in a hospital or in a rural HPSA.
The AS modifier must be on claim for assistant at surgery claims
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