Physician Assistants (PAs)

Eligible Providers

Enrolled APRNs or PAs will receive 90 percent of the physician rate and should not use modifier U7 when billing PrimeWest Health. The services of APRNs or PAs who choose not to enroll will be paid as physician extenders through the supervising physician at 65 percent of the physician rate and requires modifier U7 when billing PrimeWest Health. Registered nurse certified (RN, C) are not eligible to enroll.

Covered Services

Services performed by a PA are covered if the services are within the scope of practice for a PA as described in MN Stat. Chap. 147A and meet all required criteria by the appropriate certifying, regulatory, or licensing entities. PrimeWest Health enrolls PAs as treating providers, not pay-to providers.

Supervision of PAs

PrimeWest Health allows off-site or remote supervision of PAs, provided the terms of the physician/PA agreement are being met and the physician/PA are, or can be, easily in contact with one another by radio, telephone, or other communication device.

Off-site or remote supervision does not apply to Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs), which, under Federal regulations, require that a physician is present for sufficient periods of time, at least once every two week period (except in extraordinary circumstances which must be documented in the records of the clinic) to provide the following:

  1. Medical direction
  2. Medical services
  3. Consultation
  4. Supervision

The physician must be available through direct telecommunication for consultation, assistance with medical emergencies, and patient referral.

Billing

Bill PA services using the appropriate CPT/HCPCS codes. Follow PrimeWest Health requirements for covered physician services.

  1. Enter the NPI as the rendering provider.
  2. Use the clinic/group name and address and NPI as the billing provider.
  3. Non-enrolled PAs must use modifier U7 when billing.
  4. PAs should continue to use modifier AS when assisting-at-surgery.

Non-Covered Services

NPs and CNSs are not covered for assistant-at-surgery.