Reader Question:
Avoid Provider Type 38 for Initial NF Visit Billing
Published on Tue Mar 13, 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?Wyoming Subscriber Answer: Per Medicare rules, 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). 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, [...]
