Page 158 - Medicare Benefit Policy Manual

furnish services billed under all levels of CPT evaluation and management codes, and
diagnostic tests if furnished under the general supervision of a physician.

Examples of the types of services that PAs may provide include services that traditionally
have been reserved to physicians, such as physical examinations, minor surgery, setting
casts for simple fractures, interpreting x-rays, and other activities that involve an
independent evaluation or treatment of the patient’s condition.

See §60.2 for coverage of services performed by PAs incident to the services of
physicians.

5. Services Otherwise Excluded From Coverage

The PA services may not be covered if they are otherwise excluded from coverage even
though a PA may be authorized by State law to perform them. For example, the
Medicare law excludes from coverage routine foot care, routine physical checkups, and
services that are not reasonable and necessary for the diagnosis or treatment of an illness
or injury or to improve the functioning of a malformed body member. Therefore, these
services are precluded from coverage even though they may be within a PA’s scope of
practice under State law.

C. Physician Supervision

The physician supervision requirement under Medicare law is met under the
circumstances as follows:

Medicare Part B covers a PA’s services only if the PA performs the services in
accordance with state law and state scope of practice rules for PAs in the state in which
the PA’s professional services are furnished. Any state laws and scope of practice rules
that describe the required practice relationship between physicians and PA’s, including
explicit supervisory or collaborative practice requirements, describe a form of
supervision for purposes of the PA benefit category under section 1861(s)(2)(K)(i) of the
Act. For states with no explicit state law and scope of practice rules regarding physician
supervision of PA’s services, physician supervision is a process in which a PA has a
working relationship with one or more physicians to supervise the delivery of their health
care services. Such physician supervision is evidenced by documenting at the practice
level the PA’s scope of practice and the working relationships the PA has with the
supervising physician/s when furnishing professional services.

D. Direct Billing and Payment

Effective January 1, 2022, direct billing and payment for PA services may be made to the
PA.

E. Assignment
Assignment for PA services is mandatory.