Medicare covers services provided by physician assistants in an office or clinic at 85 percent of the physician fee schedule. Supervising physicians need not be on-site while the physician assistant performs services, but must supervise according to state law guidelines.
The CMS 1500 Claim Form should indicate that the physician assistant provided the service by including the physician assistant's National Provider Identifier (NPI) number in box 24J. The charge reported for the service should be at the physician fee schedule; the use of the physician assistant's NPI number will indicate to the Medicare carrier to pay at the 85 percent rate. The NPI number of the physician assistant's employer should go in box 33 and indicates where Medicare should send payment. Payment must always go to the physician assistant's employer.
