Mid-level provider billing

Physician assistants or nurse practitioners employed by a physician group may contract and bill Priority Health directly for surgical assists or facility rounding. All office-based services need to be billed under the supervising participating physician.

Reimbursement and coding

• Most services are reimbursed at 85% of the professional fee schedule.
• Some services will be paid at the 100% of the physician fee schedule:
• Anesthesia: codes 00000-09999, 99100-99140
• Labs, including venipuncture and radiology: codes 35415, 70000-89999
• Immunizations, vaccines and toxoids: codes 90281-90388, 90465-90749
• DME, P&O, injectibles, supplies and ancillary services: codes A0000-Z9999
• Assists with surgery should be billed using the HCPCS Level II modifier -AS, a non-physician assistant at surgery (this would include PA, CNS, CRNFA, RNFA, NP, LPN, DDS, DMD, and surgical technician provider types, subject to contract eligibility). See details about the modifier.
  

Direct billing
To be eligible for direct billing, fill out and submit a mid-level physician extender information form (40KB PDF).

Mid-level provider credentialing
We will credential mid-level providers as primary care providers if they meet the credentialing criteria for rural/underserved mid-level practitioners.