Reader Question:
Ensure That Physician Performs Initial Nursing Facility Visit
Published on Tue May 15, 2012
Question: I am receiving denial C0-170 (Payment is denied when preformed/billed by this type of provider) from Medicare when I bill for an initial nursing facility visit our physician assistant (PA) did. I am using place of service code 31 (Skilled Nursing Facility) and provider type 38 (Physician assistant). Why am I getting this denial? Answer: You cannot bill an initial visit in a skilled nursing facility (SNF) or nursing facility (NF) using 99304-99306 (Initial nursing facility care, per day, for the evaluation and management of a patient ...) under a physician assistant (PA), per Medicare rules. Medicare says that a physician must perform this type of service, per 42 Code of Federal Regulations (42 C.F.R. 483.40 [c] [4]). According to CMS, the Social Security Act states in Section 1819(b)(6)(A) that "the medical care of every resident must be provided under the supervision of a physician." This means non-physician practitioners, [...]