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Billing for PA with 80 or AS?

  1. Default Billing for PA with 80 or AS?
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    I work for an orthopedic surgeon group. Most of our physicians have a PA that assists in all surgeries. We have always been under the assumption that we bill a modifier 80 unless it's medicare and therefore you bill an AS. We have always received denials stating the assistant is not covered. We thought this was due to the actual procedure being billed and not the possibility that we should use a different modifier.
    I am receiving more specific denials now stating that the modifier is invalid and when I call inquiring what is invalid about it I am told that the PA is not considered an assistant surgeon. So are they trying to tell me without telling me straight up that I need to be billing an AS instead?
    I'm very concerned for we have been doing this for a very long time.

  2. #2
    North Carolina
    For my locality, we report modifier AS for a PA assistant. For MD's, we report modifier 80. I only have one carrier that requires modifier 80 for PA assist and that's Medicaid (this is written within their policy).
    Rebecca CPC, CPMA, CEMC

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  3. Default
    Thank you so much for your reply Rebecca. I'm hoping to get this issue resolved soon!

  4. #4

    Page 10.

    Not all Medicare carriers go by this. A friend of mine in GA said Cahaba kicked their claims when submitted per CMS guidelines. I deal with WPSMedicare and they do accept/expect AS and 80,81,or 82 for PA assist claims.

    Laura, CPC, CPMA, CEMC

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