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December 2016 Texas Medicaid Provider Procedures Manual

Medical and Nursing Specialists, Physicians, and Physician Assistants Handbook : 10 Physician Assistant : 10.2 Services, Benefits, Limitations, and Prior Authorization

Services performed by PAs are covered if the services meet the following criteria:
Services provided to Medicaid clients must be documented in the client’s medical record to include the following:
PAs who are employed or remunerated by a physician, hospital, facility, or other provider must not bill Texas Medicaid for their services if the billing results in duplicate payment for the same services.
Physicians who submit a claim using the physician’s own provider identifier for services provided by a PA must submit modifier U7 on each claim detail if the physician does not make a decision regarding the client’s care or treatment on the same date of service as the billable medical visit.
Laboratory (including pregnancy tests) and radiology services provided during pregnancy must be billed separately from antepartum care visits and claims must be received within 95 days from the date of service.
Refer to:
Section 2, “Medicaid Title XIX Family Planning Services” in the Gynecological and Reproductive Health and Family Planning Services Handbook (Vol. 2, Provider Handbooks).
Section 9, “Physician” in this handbook.
Section 5, “THSteps Medical” in the Children’s Services Handbook (Vol. 2, Provider Handbooks).

Texas Medicaid & Healthcare Partnership
CPT only copyright 2014 American Medical Association. All rights reserved.