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MP 10.01.03

Physician Assistants


Medical Policy
Section
Administrative
Original Policy Date
11/30/96
Last Review Status/Date
Reviewed by consensus/3:2003
Issue
3:2003
Return to Medical Policy Index

Disclaimer

Our medical policies are designed for informational purposes only and are not an authorization, or an explanation of benefits, or a contract.  Receipt of benefits is subject to satisfaction of all terms and conditions of the coverage.  Medical technology is constantly changing, and we reserve the right to review and update our policies periodically.


Description

A physician assistant is a specially trained individual who has met the necessary certification or licensure qualifications in the state where the services are being provided. The physician assistant performs medical functions under the direct employment or supervision of a physician.


Policy

Services provided by a physician assistant are eligible for coverage when:

  • Provided by a qualified, supervising physician or physician group;
  • Certified and recognized in the jurisdiction in which the assistants practice; and
  • The services meet all other standards of medical coverage.


Policy Guidelines

Services provided by a physician’s assistant should be reviewed by the reporting physician. Physician’s assistants are to perform under the observation, direction, and supervision of the reporting physician.


Benefit Application

BlueCard/National Account Issues

Payment for physician’s assistant services are made to the reporting physician and not directly to the physician assistant.

 

Additional or separate charges are routinely not covered.


Rationale

The information compiled for this policy was a combination of standard billing practices, Plan policies and claims experience.

Research was limited to English-language journals on humans.

 

Codes

Number

Description

CPT    Code for the service provided 
ICD-9 Procedure  No Code 
ICD-9 Diagnosis  No Code 
HCPCS  No Code 
Type of Service  Administrative 
Place of Service  Outpatient
 
Physician’s Office
 


Index

Assistant, physician
Physician assistant


Policy History

Date Action Reason
11/30/96 Add to Administrative section New policy
04/15/02 Replace policy Policy reviewed without literature review; new review date only
10/9/03 Replace policy Policy reviewed by consensus without literature review; no changes in policy; no further review scheduled


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