Mid-level provider billing

Surgical assists or facility rounding

Physician assistants or nurse practitioners employed by a physician group that is participating with Priority Health must contract and bill directly for surgical assists and/or facility rounding. 

To contract with us, use the Credentialing Supplemental Information Form.

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, DDS, DMD, and surgical technician provider types, subject to contract eligibility).

See details about modifiers 80 and 82.

Office-based services

All office-based services need to be billed under the supervising participating physician or other contracted primary care provider. The supervising physician must be billed as the rendering physician.

Reimbursement and coding

Most services are reimbursed at 85% of the professional fee schedule.

Some services may be paid at the 100% of the physician fee schedule, if you are contracted to provide them:

  • Anesthesia
  • Labs, including venipuncture and radiology
  • Immunizations, vaccines and toxoids
  • Injectables, supplies and ancillary services

Primary care designation

Nurse practitioners or physician assistants who have been credentialed and contracted by Priority Health as a primary care provider should bill us directly. These services are paid at 100% of the physician fee schedule. 

See the participation criteria for PCP designation.

Certified Nurse Midwife (CNM)

Priority Health will credential CNMs if they meet credentialing criteria. If credentialed, reimbursement will be at 100% of the regional physician fee schedule. If the CNM is not credentialed, services must be billed under supervising physician. 

See the participation criteria for Certified Nurse Midwife.