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  1. #1
    Default PA
    Exam Training Packages
    This is an area that is new to me and I wanted to verify the proper way to bill for a PA. My understanding is that if the physician is present in the office at the time of service you would bill incident to using the physician's number and if the physician is not in the office you would bill under the PA's number. Is this correct?? Also, how would you bill if the physician is out of country and the PA continues to see patients?

  2. #2
    If you bill using "incident to" the physician service, then the physician must be present in the office at the time services were rendered.. If the physician is not present for any reason, then you would bill using the PA's own name. Of course this means that he'she must be credentialed with whoever you are billing to, or the claim will process out of network.
    Walker Bachman, CPC, CPPM

  3. #3
    Sioux Falls South Dakota
    In addition to Walker's answer - you can only bill "incident to" if there is an established plan of care by the physician and the NPP is following this. For new patients and established patients with a new problem, unless the physician actually sees and examines the patient also, and documents this, you can't bill under the physician (see shared visits in Medicare Internet Only Manual). This is in the office setting. Inpatient visits have different rules.

    Hope this helps,
    Lucinda (Cindy) McGarry, CPC-P
    Applications Specialist
    Avera Health Plans
    Education Office Sioux Falls SD Local Chapter
    Past President Sioux Falls SD Local Chapter

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