My previous answer was specific to COMMERCIAL payers.

For government payers (mostly T-19 Medicaid in pediatrics, but for T-18 Medicare as well) ...

Our PAs are credentialed with their own NPI numbers. If they assist the physician - claim No 1 is for the primary surgery; claim No 2 shows the same procedure code but with AS/82 modifier (we're in a teaching hospital) and the PA as the provider, with primary surgeon listed as supervising.

We still occasionally get a denial as "duplicate" ... but a copy of the op note usually clears that up pretty quickly.

If your PA claims are being denied as "out of network" I wonder if your PA isn't credentialed?

Hope that was helpful.

F Tessa Bartels, CPC, CEMC