Eli's Rehab Report

Question: We have a physician's assistant on staff. Can he use the E/M codes to treat new patients?

Connecticut Subscriber

Answer: Not if the PA is billing his claims as "incident-to" the physician's services. Under Medicare's incident-to billing guidelines, if the claims are being submitted using the supervising physician's PIN, the physiatrist must have seen the patient at a previous encounter and developed a plan of care. But if the PA bills directly under his own PIN, he may examine and treat new patients, as long as state practice laws are followed.

When billing private payers, the PA must abide by any contractual limits placed by the insurer.