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Thread: PA's charging for Consultation

  1. #1

    Default PA's charging for Consultation

    AAPC: Back to School
    At a recent meeting that I attended we were advised that PAs and Nurse Practitioners are not supposed to charge for consults as the definition of a consultation states “ A consultation is a type of evaluation and management service provided by a PHYSICIAN at the request of another physician or appropriate source”. One of our PA's state they were advised at their PA meeting that they can charge.

  2. #2
    Join Date
    Apr 2007


    Depends on their scope of practice in your state and the guidelines of your carriers.

    In Michigan PAs and NPs can and do charge consults.

    Laura, CPC, CEMC

  3. #3
    Join Date
    Apr 2007
    Milwaukee WI

    Default Wisconsin

    Yes, our PAs / NPs can (and do) charge for consults, per state guidelines re scope of practice and documentation guidelines for CPT level.

    F Tessa Bartels, CPC, CEMC

  4. #4
    Join Date
    Apr 2007
    North Carolina


    Specifically, a consultation service is distinguished from other evaluation and management (E/M) visits because it is provided by a physician or qualified nonphysician practitioner (NPP) whose opinion or advice regarding evaluation and/or management of a specific problem is requested by another physician or other appropriate source. The qualified NPP may perform consultation services within the scope of practice and licensure requirements for NPPs in the State in which he/she practices.



    In case you need the citation...

  5. #5
    Join Date
    Apr 2007
    Greeley, Colorado

    Thumbs up

    I agree with Laura, Tessa and Rebecca. Of note, the only difference would be that if a consultation is performed for a medicare patient by an NPP they cannot bill incidet to the physician, they must bill with their own NPI.
    Happy Coding...
    Lisa Bledsoe, CPC, CPMA

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