Physician Assistant Billing Experts

Physician Assistant Medical Billing Services

Physician assistant billing follows rules similar to nurse practitioners, with reimbursement at 85% of the physician fee schedule under Medicare when billing independently.

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Physician Assistant Medical Billing Services
85%

Medicare PA reimbursement vs physician rate

15%

Revenue increase possible through incident-to optimization

168K+

Licensed PAs practicing in the U.S.

28

States with full PA practice authority

Overview

Optimized Billing Strategies for PA-Driven Practices

Physician assistant billing follows rules similar to nurse practitioners, with reimbursement at 85% of the physician fee schedule under Medicare when billing independently. Incident-to billing at 100% is available when the PA provides services under direct physician supervision with an established patient on a physician-initiated plan of care. The supervising physician must be in the office suite, not merely available by phone, for incident-to billing to be compliant.

Credentialing PAs with commercial payers has become easier in recent years, but inconsistencies remain. Some payers credential PAs and reimburse at the physician rate, while others maintain the 85% reduction or require billing under the supervising physician's NPI. Shared visit rules for hospital-based PA services add another layer of complexity, with CMS and commercial payers maintaining different standards for split/shared visit documentation.

Optimized Billing Strategies for PA-Driven Practices
Challenges

Common Physician Assistant billing Challenges We Solve

Every Physician Assistant billing team deals with payer delays, coding nuance, and collection leakage.

Incident-To Compliance Requirements

Incident-to billing at 100% of the physician rate requires the physician to have initiated the care plan, be physically present in the office suite, and the visit must be for an established patient with an existing condition. Violations trigger audits and repayment demands.

Shared Visit Documentation

Shared visits require clear documentation of which provider performed the substantive portion of the encounter. Ambiguous documentation defaults to the PA's NPI at 85% reimbursement, leaving revenue on the table.

State Supervisory Agreement Variations

PA practice authority varies by state, from full practice authority to required physician supervision agreements with specific documentation. Billing must align with the supervisory model in each state.

Credentialing Across Multiple Payers

PAs must be individually credentialed with each payer to bill under their own NPI. Gaps in credentialing prevent billing and create revenue loss during the enrollment period.

Services

Complete Physician Assistant billing Services

Support spans the full revenue cycle.

Incident-To Billing Optimization

Shared Visit Documentation Compliance

PA Credentialing and Payer Enrollment

Supervisory Arrangement Documentation

Revenue Modeling for PA Billing Strategies

Multi-Provider Practice Billing Coordination

Coverage

Serving Physician Assistant billing Teams Nationwide

We support independent practices and growing provider organizations.

Independent physician groups

Multi-location practices

Private equity backed platforms

Hospital-owned outpatient groups

Guide

The Complete Guide to Physician Assistant billing

Physician assistants generate substantial practice revenue, but billing optimization requires understanding the different reimbursement scenarios available. When a PA bills under their own NPI, Medicare reimburses at 85% of the physician fee schedule. However, incident-to billing allows PA services to be billed under the supervising physician’s NPI at 100% of the fee schedule, provided strict CMS requirements are met: the physician must have initiated the plan of care, must be present in the office suite during the PA’s service, and the patient must be an established patient with an existing condition. These requirements create a decision matrix for every patient encounter.

Shared visit billing adds another dimension. In the facility setting (hospital, ED, skilled nursing), a physician and PA can both see the same patient, and the visit is billed under whichever provider performed the substantive portion, defined as more than half of the total time or the key portion of the medical decision-making. The 2024 CMS shared visit rules clarified these requirements, and our billing team ensures that documentation clearly establishes which provider performed the substantive portion. For practices employing multiple PAs, we model the revenue impact of different billing strategies and help implement the approach that maximizes reimbursement while maintaining full compliance.

Common Questions

Frequently Asked Questions About Physician Assistant billing

Answers to the questions practice owners ask most often.

Incident-to billing submits the PA's services under the supervising physician's NPI at 100% of the fee schedule. Billing under the PA's NPI uses the PA's own credentials at 85% of the fee schedule. Incident-to has strict requirements (physician-initiated care plan, physician present in suite, established patient), while own-NPI billing has no such restrictions.

Bill incident-to when all requirements are met: established patient, existing condition with physician-initiated treatment plan, and supervising physician present in the office. Bill under the PA's NPI for new patients, new conditions, hospital visits, home visits, or any encounter where the physician is not in the office suite.

In hospitals and facilities, when both a PA and physician see the same patient on the same day, the visit is billed under the provider who performed the substantive portion. Under current CMS rules, substantive portion is defined by who performed more than half of the total time or the key component of medical decision-making.

No, the 85% rate is specific to Medicare. Commercial payers set their own PA reimbursement rates through contract negotiations, and some pay PAs at 100% of the physician rate. Medicaid rates vary by state. We help practices understand and negotiate PA reimbursement rates with each payer.

In states with full practice authority, PAs can practice and bill independently without a supervisory agreement. We ensure that PA credentialing applications reflect full practice authority status and that billing is set up to capture services at the highest available rate for independent PA practice.

Common pitfalls include billing incident-to without the physician present, using incident-to for new patients or new conditions, failing to document the substantive portion provider in shared visits, and not maintaining current supervisory agreements. We audit documentation practices to identify and correct these issues.

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