PA performing injections in an ASC

kdsampson

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Joplin, MO
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I have a PA that's planning on doing epidural and SI joint injections in an ASC setting. He is planning on doing these injections without the dr in the OR. I'm trying to find billing guidelines to know how to correctly bill these services. Will it be the same as the dr, but he'll just be reimbursed at a lower rate? Any help is appreciated, I'm not coming up with anything by googling.
 

mitchellde

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Columbia, MO
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You must use the PA's NPI number, you cannot bill these using the physician. The PA NPI will go in 24J and his signature will go in 31.
 

nrichard

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Pensacola, Fl
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You may also want to check some of your insurance fee schedules.

I'm in Florida and I have access to some of my payer fee schedules for PA's, and ARNPs. Example Medicaid. I've been advised that if the CPT code isn't on their fee schedule, it means that the procedure is not payable to this type of provider. I say this because some of my insurance companies will pay a PA to perform certain procedures, while others that I report the same CPT code will not.
 

dwaldman

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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.

http://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/bp102c15.pdf

Page 141

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
http://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/clm104c12.pdf
Page 171
 
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