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Thread: Medicare Replacement Plans

  1. #1

    Default Medicare Replacement Plans

    AAPC: Back to School
    Hi, We are having a problem with United Healthcare Medicare in Pennsylvania. They are trying to tell us to bill services of the physician assistant under the dr's name. We are trying to tell them that we can't because we will be overpaid and it is incorrect billing. (The main problem is with E/M code). Also, all of are other Physician Assistants we bill under their own name and are paid correctly with no problem. They are telling us just to bill one of our PA's under the dr's name. They are stating that there is a Pennsylvania state code which overrides Medicare stating PA's can not bill directly for their services. The only thing I can find is PA state code 49 18.152 which states that the Physician Assistants can not independently provide and bill patient's for their services. This is not happening because all of our Physician Assistants are supervised and the dr reviews and countersigns notes and orders. Anyone else have anything to add or give advice as to how to resolve this issue?

    Thank you!

  2. #2
    Join Date
    Apr 2007


    how about modifier -SA we need to use this for medicaid plans

  3. #3


    Do you mean modifier AS? We do use this for surgeries, the particular problem we are having is with E&M's.

  4. #4
    Join Date
    Apr 2007
    Baton Rouge


    Quote Originally Posted by penguins11 View Post
    Do you mean modifier AS? We do use this for surgeries, the particular problem we are having is with E&M's.
    SA can be used for PA's on their E & M codes, we have to use it for our extenders that see Blue Cross patients, but I haven't heard of United Healthcare requesting that modifier. So possibly for the one PA that you are having trouble billing, put the supervising physician's name on the claim, with the SA modifier on the E & M code ??
    Meagan Strauss, CPC, CEMC
    Coding Coordinator
    The NeuroMedical Center
    Baton Rouge, LA

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