UPMC Health Plan is not forthcoming with their rules and guidelines for billing such services. I have contacted customer service and the provider relations representative. Both tell me they cannot "tell me how to bill", which is funny to me, because I did not ask how to bill. Their guidelines are not within their provider manual. The last documented information I can find on the topic is from 2009. I do know this insurance does not credential PA-Cs, so we cannot bill the PA-C charges as a servicing and billing provider. We probably can bill the PA-C under the supervision of the M.D., however, unlike most of carriers in our area (including Medicare) I cannot find UPMC's rules. One of our major carriers wants an -80 and -AS modifiers on the physician's assistant charges, which is strange since an -80 is typically considered an M.D. / D.O. assisting, but at least I was able to find those guidelines to show our practice manager.
I have a huge back log of charges and cannot seem to get any at UPMC to help me with this. Could anyone out there share any advice? Maybe I am not looking in the right place(s) for guidelines...
THANKS!
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Physician Assistant as an assistant surgeon