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Thread: PA and medicare

  1. #1

    Default PA and medicare

    AAPC: Back to School
    I have a PA in the office. Past inquires have lead me to believe that a PA cannot see new patients with Medicare or goverment type insurances-- he can only see COMMERCIAL insurances as new patients. It is now 2009 --
    is there a new code that has come out that a PA can see the New Pt gov't insurances? -- paying at a lesser rate?

  2. #2
    Join Date
    Apr 2007


    I have never heard of that ?? Can anyone clarify this with an article or some medicare guidelines ? I bill for physician's of a hospital so maybe our guidelines are different but we have always billed PA's.

  3. #3
    Join Date
    Apr 2007

    Default PA and Medicare

    Does your state allow PA's to see new patients? You need to verify this. If your practice has a physician, they you need to check with him or her, or the office manager. Generally, many practices only allow the physician (M.D. or D.O.) to perform a new patient visit, for quality of care reasons. If the practice does allow the PA to perform a new pt. visit, they you have to bill under the PA's Provider number, not the physicians. Under Medicare, payment is reduced to 85% of the physicians fee schedule amount for the same visit, if performed by the PA. (See Medicares "IncidentTo" rule) You still code the appropriate (and same) E & M CPT code. For other payers, you need to review their requirements and policies.

  4. #4
    Join Date
    Apr 2007
    North Carolina


    A PA may see and treat new Medicare patients and provide a service within his or her state law guidelines for scope of practice as long as the state’s supervision requirements are met.The claim should be submitted with the PA’s NPI number.

    I would begin reading at section 60

    Last edited by RebeccaWoodward*; 01-28-2009 at 01:55 PM.

  5. #5
    Join Date
    Apr 2007
    Greeley, Colorado


    Rebecca is absolutely correct. As long as it is within the State Scope of Practice, the PA can see a new patient using his/her own NPI#. Reimbursement is made at I believe 85% or what an MD would be reimbursed.
    Lisa Bledsoe, CPC, CPMA

  6. #6
    Join Date
    Apr 2007


    I believe you are referring to "incident to billing". If a PA bills thru the dr instead of his own number then the PA can only see medicare pts who are established and a treatment plan is established meaning no new patients and no established pts with new problems. Now if the PA bills thru his own numbers he can see all medicare pts he just gets reimbursed at a lower rate but you can also do both so I would credential with medicare to bill for those times when you can not follow incident to guidelines and bill thru the dr for a higher reimbursement when you can follow incident to guidelines.

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