PA Reimbursement


Federal Health Laws regulate Medicare and guide reimbursement for Physician Assistant services. Depending on the practice situation, the services of the PA are reimbursable at a percentage of the physician rate by most insurance companies, workers' compensation and major federal programs. The claim is submitted at the full physician rate for payment and the National Provider Identification number (NPI) number of the Physician Assistant will notify Medicare that the reimbursement should be reduced to 85% schedule.

Below is a summary of various situations and their expected reimbursement levels:

PA reimbursement is 85 percent of physician fee schedule/physician first assist fee schedule when the PA is:

  • In the Office/Clinic when physician is not on site
  • Performing a Home visit/
House call (not same as home health services) 
  • Working in a Skilled Nursing Facility & Nursing Facility
  • First assisting at surgery in all settings
  • Working in the hospital providing a non-shared visit service

PA reimbursement is 100 percent of physician fee schedule (use Medicare guidelines for "incident-to" services) when the PA is:

  • In the Office/Clinic when physician is on site in the suite of offices
  • Working in the hospital providing a shared visit service (Use Medicare guidelines for shared services)
  • Other Reimbursement - Capitation basis
  • HMO
  • Other Reimbursement - Cost-based reimbursement
  • Federally Certified Rural Health Clinics

 

UAMS PA Program
UAMS PA Program
About Arkansas
 
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Little Rock, AR 72205-7199