|
SETTING |
SUPERVISION |
REIMBURSEMENT RATE |
SERVICES |
|
Office/Clinic when physician is not on site |
State Law |
85% of physician fee schedule |
All services PA is legally authorized to provide that would have been covered if provided personally by a physician |
|
Office/Clinic when physician is on site |
Physician must be in the suite of offices |
100% of physician fee schedule 1 |
Any service provided to an established patient of the practice and related to an ongoing condition for which a plan of care was established by a physician of the practice |
|
Home visit/ |
State Law |
85% of physician fee schedule |
All services PA is legally authorized to provide that would have been covered if provided personally by a physician |
|
Skilled Nursing Facility & Nursing Facility |
State Law |
85% of physician fee schedule |
PA may not do initial comprehensive visit in a SNF; may provide alternating scheduled and all unscheduled visits. |
|
Hospital; non-shared visit service |
State Law |
85% of physician fee schedule |
All services PA is legally authorized to provide that would have been covered if provided personally by a physician, consistent with hospital by-laws. |
|
Hospital; shared visit service |
State Law |
100% of physician fee schedule3 |
Any non-consultation E/M service; does not apply to procedures or critical care; consistent with hospital by-laws |
|
First assisting at surgery in all settings |
State Law |
85% of physician first assist fee schedule4 |
All services PA is legally authorized to provide that would have been covered if provided personally by a physician |
|
Federally Certified Rural Health Clinics |
State Law |
Cost-based reimbursement |
Same As Above |
|
HMO |
State Law |
Reimbursement is on capitation basis |
All services contracted for as part of an HMO contract |
1 Using Medicare guidelines for "incident to" services.
2 Not to be confused with home health services
3Using Medicare guidelines for shared services.
4i.e. 85% x 16% = 13.6% of surgeon's fee.
