Wiki Provider Type Denials from Medicare

[lacykoch]

We are an orthopedic group submitting physician assistant claims to Medicare. Medicare is denying some of our procedures stating "this provider type/specialty can not bill for the procedure performed." When we call Medicare, they can not give us a policy or guideline that shows what codes the PA's can and can not bill for. When we look at the Medicare Fee Schedule, CPT code book, and the state scope of practice, the codes we are billing are payable. Any suggestions or help?

 

[mitchellde]

It has to do with individual state licensure for PAs. Medicare is going to default to your state. Every state is a little bit different in the scope of practice for PAs. I suggest you check with your state licensing board.