Results 1 to 6 of 6

Physician Assistant Billing - Medicare products

  1. Default Physician Assistant Billing - Medicare products
    Clearnace Sale
    Hi, I have a question about coding for a physician assistant. I understand about "incident to" and Medicare or Medicare products but does incident to apply to private insurances also or is it just Medicare? I've called a couple of insurance companies and they say to bill under the supervising doctor's NPI number. Does that mean the PA can see new patients? Any help would be appreciated. Thank you.

  2. #2
    Milwaukee WI
    Default INcident to is MediCARE only
    The official rules for "incident to" billing apply ONLY to MediCARE (and perhaps your state's MedicAID if they follow Medicare to the letter).

    We do not bill "incident to." Our PAs and NPs are credentialed with Medicare and Medicaid and bill services they provide under their own names/NPI numbers.

    Our commercial carriers do not credential PAs and NPs. They ask that we submit services by these allied health professionals under the name/NPI of the supervising physician - which is what we do.

    Our coding/billing software allows us to enter the charges under the actual provider (e.g. PA Smith), while sending the claim out under the supervising physician (e.g. Dr Jones). This way we have a clear understanding of who actually provided the service.

    We have no problem getting paid - even when documentation is requested.

    Hope that helps.

    F Tessa Bartels, CPC, CEMC
    Last edited by FTessaBartels; 02-09-2010 at 01:14 PM.

  3. Default
    THanks Tessa! Just to be absolutely clear, for the commercial carriers, you can bill out new patients under the supervising physician's NPI number?

  4. #4
    Default From Florida
    I'm in FL and BCBS recently started credentialing ARNP's and PA's. The only problem is, they are considered a specialist (believe it or not) so the patient may have a higher co-pay. This is not making our pts very happy.
    adrianne, cpc

  5. #5
    Evansville Indiana
    Default Incident to
    Many of the commercial carriers follow incident to guidelines. You would need to check with the individual carriers. We had someone call all our major carriers and they pretty much all said they follow CMS guidelines, and if that is the case, then no, they can't see new patients. Your best bet is to check with each individual carrier.

  6. #6
    Columbia, MO
    You cannot charge incident to for a new patient since the physician you are billing under has had no material participation in this patient's care and that is one of the basic provisions of incident to.

    Debra A. Mitchell, MSPH, CPC-H

Similar Threads

  1. Billing for a Physician Assistant
    By kjoseph in forum Medical Coding General Discussion
    Replies: 5
    Last Post: 02-07-2018, 10:33 AM
  2. Physician Assistant Billing
    By moralesc17 in forum Billing/Reimbursement
    Replies: 2
    Last Post: 05-12-2014, 12:05 PM
  3. Replies: 4
    Last Post: 11-08-2012, 08:49 AM
  4. Billing for Physician Assistant
    By Texascoder64 in forum Billing/Reimbursement
    Replies: 3
    Last Post: 08-20-2012, 03:09 PM
  5. Billing/Physician Assistant
    By careyd in forum Medical Coding General Discussion
    Replies: 5
    Last Post: 02-07-2012, 12:15 PM

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts
Enjoying Our Forums?

AAPC forums are a benefit of membership. Joining AAPC grants you unlimited access, allowing you to post questions and participate with our community of over 150,000 professionals.

Join Now Continue Reading Without Full Access

Already a Member?


Close Message

In addition to full participation on AAPC forums, as a member you will be able to:

  • Access to the largest healthcare job database in the world.
  • Join over 150,000 members of the healthcare network in the world.
  • Be a part of an industry leading organization that drives the business side of healthcare.
  • Save anywhere from 10%-50% with exclusive member discounts on courses, books, study materials, and conferences.
  • Access to discounts at hundreds of restaurants, travel destinations, retail stores, and service providers. AAPC members also have opportunities to save on heath, life, and liability insurance.
  • Become a member of a local chapter and attend regular meetings.