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Question on Physician Assistants

  1. #1
    Question Question on Physician Assistants
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    Good Morning,
    I am hoping someone can help me with this. Our physicians are allowing PA's to perform surgeries. Medicare has denied a claim for this reason. In my research, I cannot find any clear cut Medicare rule stating that PA's cannot perform surgeries. In fact, all I can find is that a PA's scope of service is determined by the state. Does anyone have any information they could share?
    Thank you in advance.

  2. #2
    I agree that Medicare does not limit the services that a PA can provide. The only guidelines are in Chapter 15 of the Medicare Benefit Policy Section 190. It specifies that the PA may render:

    B. CoveredServices

    Coverage islimited to the services a PA is legally authorized to perform in accordancewith State law (or State regulatory mechanism provided by State law).

    Examples of the types of services that PAs may provide include services that traditionally havebeen reserved to physicians, such as physical examinations, minor surgery,setting casts for simple fractures, interpreting x-rays, and other activitiesthat involve an independent evaluation or treatment of the patient’s condition.

    So you next question would be to determine any limitation within your state.

    Chelle Johnson, CPC CPMA CDEO CEMC CPCO CPPM AAPC Fellow
    Billing/Coding/Credentialing/Auditing Coordinator

    20+ years experience in Medical Billing and Auditing

  3. #3
    Thank you Chelle-Lynn. I appreciate your help.

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