Forum - Questions & Answers

Oct 6th, 2015 - marymanager

How do we bill ? PA saw the pt ...

Our PA sees patients - office visits as well as minor surgical procedures - now there are questions as to whether we are billing her claims correctly. Can't use her NPI or License # on claims because most of the insurance companies don't even credential PA's , versus as when we bill Medicare they already know it's a PA because she is PECOS enrolled , has NPI, UPIN, etc and t's all on the claim and they pay only 85% to an PA.

So, is there a modifier we should be using to tell the other insurance companie (BCBS, United, Humana--) that it's a PA seeing the pt ?

Is it modifier SA for office visits? what about minor surgical procedures?

Oct 6th, 2015 - sabrinagen 5 

re: How do we bill ? PA saw the pt ...

It differs for each insurance, some require the modifier and some dont. SA is the modifier for NP's, -AM or -HN is typically the modifier used for physician assistants.

Many insurance companies are now credentialing PA's. Unfortunately, there isn't one place to look you have to look on individual insurance websites and call to obtain their PA billing guidelines & requirements.

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