How do you bill under a supervising physician?
Asked by: William Wiegand DDS | Last update: August 7, 2025Score: 4.5/5 (39 votes)
What is the modifier for supervising a physician?
SA Modifier: A supervising physician should use this modifier when billing on behalf of a PA, APN, of CRNFA for non-surgical services. (Modifier SA is used when the PA, APN, or CRNFA is assisting with any other procedure that DOES NOT include surgery.)
How to bill for locum tenens physician?
Claims must contain the NPI of the regular physician and not the locum or substitute physician. This is entered in CMS-1500 claim in block 24J. CPT/HCPCS codes must have the modifier Q6 appended as this would indicate that the billed services were furnished by the locum or substitute physician.
What is supervising provider in medical billing?
The Supervising Provider is the individual who provided oversight of the Rendering Provider and the care being reported. An example includes, but is not limited to, supervision of a resident physician.
Where does the supervising physician go on the CMS-1500?
Similarly, if Medicare policy requires you to report a supervising physician, enter this information in item 17. When a claim involves multiple referring, ordering, or supervising physicians, use a separate CMS-1500 claim form for each ordering, referring, or supervising physician.
Billing for NPs and PAs Office Visits
Can you bill for a PA under the supervising physician?
Yes, most do. Some carriers bill for the PA directly, while others bill through the supervising physician.
What goes in box 23 on a CMS 1500?
Box 23 - TITLE: Prior Authorization Number (this field is also used for CLIA numbers) • INSTRUCTIONS: Enter any of the following: prior authorization number, referral number, or Clinical Laboratory Improvement Amendments (CLIA) number, as assigned by the payer for the current service.
What is a supervising physician?
The supervising physician is responsible for all medical services provided by the PA under their supervision and for following each patient's progress.
How does supervisory billing work?
Billing Responsibility: The supervisor takes responsibility for billing and reimbursement on behalf of the provisionally licensed provider. This means that the services provided by the associate are billed under the supervisor's name and credentials.
Can a non-credentialed provider bill under another provider?
Although practices may be able to bill non-credentialed physician's services with a credentialed physician's NPI under Medicare's “incident to” rules, commercial payers may not allow “incident to” billing. Similarly, commercial payers may not allow locum tenens or reciprocal billing arrangements.
What is the modifier for a locum tenens physician?
The Q6 modifier is a procedure code modifier used on medical claims for the billing of services for a locum tenens physician.
Do locums need to be credentialed?
The answer is yes. State and federal laws require hospitals to have a process in place to screen all applicants and assess their professional abilities. That's why physicians, physician assistants, and nurse practitioners must undergo a thorough credentialing process prior to taking on a locum tenens assignment.
Which form is used to bill for independent physician services?
Form CMS-1500
CMS allows providers to submit a paper claim if they meet the Administrative Simplification Compliance Act (ASCA) exceptions. Sometimes providers use the CMS-1500 and the 837P to bill certain government and private insurers.
What is an example of a supervising physician attestation statement?
I, , as the supervising physician, am a self-attested, qualifying physician, and I provide direct professional oversight and assume legal responsibility for the services provided by the advanced practice clinician, listed above, who is providing services within their scope of practice.
When should I use the SA modifier?
You should use modifier SA Nurse practitioner rendering service in collaboration with a physician for supervised NP services, when the insurer requires the modifier. Medicare does not accept modifier SA, and other payers may specify unique requirements.
Why would a TC be billed and not PC?
Modifier TC is used when only the technical component (TC) of a procedure is being billed when certain services combine both the professional and technical portions in one procedure code. Use modifier TC when the physician performs the test but does not do the interpretation.
Which insurance companies allow supervisory billing?
How does Incident To/Supervisory Billing Work? Incident-to billing is permitted by specific insurers and varies by state. In New York, as of the time this blog is published (2023), AETNA and CIGNA are two insurers allowing supervisory billing.
What is the HO modifier used for?
The HO modifier is used to identify mental health services provided by professionals holding a Master's degree in a related field, such as psychology, counseling, or social work. It indicates that the services were rendered by a mental health professional with an advanced level of education and training.
Does Medicare allow supervised billing?
Incident-to billing allows NPPs to provide follow-up services under the direction of a supervising physician and bill under the doctor's national provider identifier (NPI) number, resulting in a greater Medicare reimbursement rate.
What is the difference between an attending physician and a supervising physician?
Attending physicians are sometimes the 'rendering physician' listed on the patient's official medical record, but if they are overseeing a resident or another staff member, they are 'supervising. '
Does a supervising physician have to be on site?
(CCR 3516(b)) Schedule II-V Supervisory A supervising physician shall be available in person or by electronic communication at all times when the PA is caring for patients.
Which specialist works under a physician's supervision?
Physician assistants examine, diagnose, and treat patients under the supervision of a physician.
What goes in box 22 on a CMS 1500?
If you are submitting a void/replacement paper CMS 1500 claim, please complete box 22. For replacement or corrected claim enter resubmission code 7 in the left side of item 22 and enter the original claim number of the claim you are replacing in the right side of item 22.
What goes in box 24 on a CMS 1500?
The Billing Items section includes the following information that populates into Box 24 on the CMS 1500 claim form: Date of Service (Last Session, Custom Date, Today, Date Range) Procedure (CPT) Codes. Units.
What is box 27 on CMS 1500?
Under this method, the provider agrees to accept the Medicare approved amount as full payment for covered services. Item 27 on the CMS-1500 claim form allows the provider to indicate whether they accept or do not accept assignment.