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PA billing

  1. Default PA billing
    Medical Coding Books
    When a PA is assisting the doctor in the office on a surgery can the PA bill too?

  2. #2
    Greeley, Colorado
    Only if the procedure allows for an assist...and use mod -AS.

  3. #3
    North Carolina
    There are surgeries that will warrant the use of an assistant...if medically necessary. The modifier will vary from state to state to indicate that it is an assistant. Our region requires modifier AS with the exception of Medicaid. They require modifier 80. There are various sources you can refer to that will indicate whether or not the service is payable for a PA. The physician must dictate the role of the PA to warrant medical necessity. Simply dictating the PA's name won't cut it.
    Rebecca CPC, CPMA, CEMC

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  4. #4
    Milwaukee WI
    Default Teaching Hospital
    Additionally, if you are in a teaching facility, the physician must dictate that "No qualified resident was available to assist, so PA Name assisted in this procedure." AND you would use modifier -82.

    F Tessa Bartels, CPC, CPC-E/M

  5. #5
    Default Determining if an assistant is allowable
    This information is available through CMS (on the fee schedule), but UMD was nice to consolidate them into a user-friendly list.

    Medicare pays for an assistant where 95% of surgeons bill for an assistant. That means if less than 5% of surgeons report an assistant for a specific CPT, Medicare won't pay.
    Belinda S. Frisch, CPC, CEMC
    Author of "Correct Coding for Medicare, Compliance, and Reimbursement"

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