Home Forums Discussions Coding and Billing HELP: How To Bill For Physician Assistant

Hello Docs-

I've hired a PA who has their own NPI number and I am trying to learn how to bill and fill out the CMS-1500 for their work. I understand the medicare "incident-to" rules and some of my commercial carriers have credentialed the PA and some say to bill under my NPI.

So, with respect to the CMS-1500 (which we submit via ACPM), and the various Lines:

1) With Medicare, when the PA sees the patient "incident to", and I am the supervising physician, whose name or NPI number goes on Lines 17, 17b, 24J, 31?

2) With Medicare, when the PA sees the patient on their own (ie, we will get 85% of the full payment), whose name or NPI number goes on Lines 17, 17b, 24J, 31?

3) Same question when the insurance is a commercial carrier that does NOT credential the PA? Whose name or NPI number goes on Lines 17, 17b, 24J, 31?

Thanks to anyone who can provide a factual response (ie, telling me that you simply bill under your own NPI and leave the PA off the claim is not what I'm looking for!)
LOL.

SANDY

MARTIN DERMATOLOGY
FORT MYERS, FL

Hi Sandy,

Though I am not a doctor but billing is my bread and butter So I guess I can help you with this

1) With Medicare, when the PA sees the patient "incident to", and I am the supervising physician, whose name or NPI number goes on Lines 17, 17b, 24J, 31?

box 17 will have referred provider name and NPI or if not referred by anyone then you can use your own name and NPI there , both works for Medicare
Box 24J will have your NPI
Box 31 will have your signature

2: With Medicare, when the PA sees the patient on their own (ie, we will get 85% of the full payment), whose name or NPI number goes on Lines 17, 17b, 24J, 31?

box 17 will have referred provider name and NPI or PA name and NPI can be used, both works for Medicare
Box 24J will have PA NPI
Box 31 will have PA signature

3) Same question when the insurance is a commercial carrier that does NOT credential the PA? Whose name or NPI number goes on Lines 17, 17b, 24J, 31?

In Commercial , if not credential, follow the first combination

Thanks to anyone who can provide a factual response (ie, telling me that you simply bill under your own NPI and leave the PA off the claim is not what I'm looking for!)

i would suggest Follow your OWN NPI and bill as incident to if you are supervising and on the same location , provider must be in the same building
Also do read about incident to so you get to know all the rules before you bill them

I hope this helps

Sincerely,
Jay Oram
www.SybridMD.com

THANK YOU Jay.

Sandy