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Thread: PA billing ? modifier

  1. #1

    Default PA billing ? modifier

    AAPC: Back to School
    We are having trouble finding the modifier to use for billing physician assistants in a doctors office setting. Everything I find relates to surgery, however, Medicaid (Indiana) is stating that the services be billed under the doctor but with a modifier???? They will not tell us what modifier they are looking for. We called the local hospital and they said they are adding -25, could anyone confirm that this is the appropriate modifier. Any help is greatly appreciated.

  2. #2


    I could only find mod SA definition is: Nurse practitioner rendering service in collaboration with a physician but could not find anything for a PA specifically.
    This is my resource for mod 25:
    It may be necessary to indicate that on the day a procedure or service identified by a CPT code was performed, the patient's condition required a significant, separately identifiable E/M service above and beyond the other service provided or beyond the usual preoperative and postoperative care associated with the procedure that was performed. A significant, separately identifiable E/M service is defined or substantiated by documentation that satisfies the relevant criteria for the respective E/M service to be reported (see Evaluation and Management Services Guidelines for instructions on determining level of E/M service). The E/M service may be prompted by the symptom or condition for which the procedure and/or service was provided. As such, different diagnoses are not required for reporting of the E/M services on the same date. This circumstance may be reported by adding modifier 25 to the appropriate level of E/M service. Note: This modifier is not used to report an E/M service that resulted in a decision to perform surgery. See modifier 57. For significant, separately identifiable non-E/M services, see modifier 59.

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