Results 1 to 4 of 4

Medicare Replacement Plans

  1. Default Medicare Replacement Plans
    Medical Coding Books
    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
    how about modifier -SA we need to use this for medicaid plans

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

  4. #4
    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

Similar Threads

  1. KX modifer for Humana Medicare Replacement plans
    By in forum Modifiers
    Replies: 0
    Last Post: 09-11-2014, 11:32 AM
  2. Medicare Replacement Plans
    By pglazener in forum Billing/Reimbursement
    Replies: 3
    Last Post: 02-02-2012, 06:48 AM
  3. Medicare Replacement Plans
    By Bran19 in forum Billing/Reimbursement
    Replies: 2
    Last Post: 11-09-2010, 10:29 PM
  4. Medicare Replacement Plans
    By dcarr in forum Pathology & Clinical Laboratory
    Replies: 0
    Last Post: 09-29-2009, 03:33 PM
  5. Medicare replacement plans?
    By moricecrys in forum Medicare Regulations
    Replies: 3
    Last Post: 04-14-2009, 09:00 AM

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts
Enjoying Our Forums?

AAPC forums are a benefit of membership. Joining AAPC grants you unlimited access, allowing you to post questions and participate with our community of over 150,000 professionals.

Join Now Continue Reading Without Full Access

Already a Member?


Close Message

In addition to full participation on AAPC forums, as a member you will be able to:

  • Access to the largest healthcare job database in the world.
  • Join over 150,000 members of the healthcare network in the world.
  • Be a part of an industry leading organization that drives the business side of healthcare.
  • Save anywhere from 10%-50% with exclusive member discounts on courses, books, study materials, and conferences.
  • Access to discounts at hundreds of restaurants, travel destinations, retail stores, and service providers. AAPC members also have opportunities to save on heath, life, and liability insurance.
  • Become a member of a local chapter and attend regular meetings.