Wiki "Rendering provider" for MA-performed services

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CatchTheWind

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If a service such as light box, photodynamic therapy, IM injection, etc. is performed by a medical assistant (while a doctor is present in the office), whom do you list as the "rendering provider" (field 24J on the CMS-1500)?

We always thought it is the doctor (since the MA does not even have an NPI), but the new division of photodynamic therapy codes in 2018 that depend on whether it is performed by the provider or auxiliary staff made us wonder about it.
 
Rendering Provider for MA-performed services

In your AMA CPT book 2017 page xii third paragraph under "Instructions for Use of the CPT Codebook" it states:
"A "physician or other qualified health care professional" is an individual who is qualified by education, training, licensure/regulation (when applicable), and facility privileging (when applicable) who performs a professional service within his/her scope of practice and independently reports that professional service. These professionals are distinct from "clinical staff." A clinical staff member is a person who works under the supervision of a physician or other qualified health care professional and who is allowed by law, regulation, and facility policy to perform or assist in the performance of a specified professional service, but who does not individually report that professional service."

I hope this helps.
 
CatchTheWind said:
If a service such as light box, photodynamic therapy, IM injection, etc. is performed by a medical assistant (while a doctor is present in the office), whom do you list as the "rendering provider" (field 24J on the CMS-1500)?

We always thought it is the doctor (since the MA does not even have an NPI), but the new division of photodynamic therapy codes in 2018 that depend on whether it is performed by the provider or auxiliary staff made us wonder about it.
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You are following general supervision, and you bill these services under the supervising provider that day in the office.

Same goes for the 2018 96567 CPT code (Clinical staff-provided PDT). You bill under the supervising provider as clinical staff will not have an NPI number. The reimbursement is about $77 less on 96567 next year because it doesn't account for any physician work RVUs. That's how you can still bill 96567 under a supervising provider's NPI number, or 96573 under the NPI of the actual provider that did the services.


I'm releasing a free mini-webinar that goes over all of the new PDT rules shortly.
 
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