The physician is required to provide direct supervision of the physician assistant even if the physician does not see the patient. The payer interprets the definition of direct supervision, but historically physicians have been allowed to review a case and co sign the chart without seeing the patient. In the emergency department, the service must be billed under the PA's provider number. Medicare requires that the AN modifier be used when billing.
Strict conditions apply.
Examples of supplies include bandages, ointments, and oxygen. In other words, receiving payment at the higher physician reimbursement rate for physician assistant services is prohibited by Medicare. Depending on state regulations, physician assistants can still manage emergency department patients but be careful, state regulations vary considerably. No matter the context, physician assistants and nurse practitioners must comply with state licensure law before any Medicare issues can be considered. In cases where state law is more liberal than Medicare's regulations, Medicare policy take precedence.