Page 157 - Medicare Benefit Policy Manual

1. General

The services of a PA may be covered under Part B, if all of the following requirements
are met:

• They are the type that are considered physician’s services if furnished by a
doctor of medicine or osteopathy (MD/DO);

• They are performed by a person who meets all the PA qualifications,

• They are performed under the general supervision of an MD/DO;

• The PA is legally authorized to perform the services in the state in which they
are performed; and

• They are not otherwise precluded from coverage because of one of the
statutory exclusions.

2. Incident To

If covered PA services are furnished, services and supplies furnished incident to the PA’s
services may also be covered if they would have been covered when furnished incident to
the services of an MD/DO, as described in §60.

3. Medical Record Documentation for Part B Services

This medical record documentation requirement applies to Part B professional services
that are paid under the Medicare physician fee schedule. Accordingly, for Part B
physician assistant covered services, the physician assistant may review and verify (sign
and date), rather than re-document notes in a patient’s medical record made by
physicians, residents, nurses, medical; physician assistant; nurse practitioner; clinical
nurse specialist; certified nurse-midwife; and certified registered nurse anesthetist
students or other members of the medical team, including as applicable, notes
documenting the physician assistant’s presence and participation in the service.

For documentation requirements specific to E/M services furnished by physicians and
certain nonphysician practitioners, see Chapter 12, section 30.6 of the Medicare Claims
Processing Manual, publication 100-04.

4. Types of PA Services That May Be Covered

State law or regulation governing a PA’s scope of practice in the State in which the
services are performed applies. A/B MACs (B) should consider developing lists of
covered services. Also, if authorized under the scope of their State license, PAs may