For a physician assistant to be an eligible Medicare provider, he or she must meet the following requirements:
- Have graduated from a physician assistant education program that is accredited by the Accreditation Review Commission on Education for the Physician Assistant or, prior to 2001, either by the Committee on Allied Health Education and Accreditation or the Commission on Accreditation of Allied Health Education Programs; or
- Have passed the national certification examination administered by the National Commission on Certification of Physician Assistants (NCCPA); and
- Be licensed or certified by any states in which he or she wishes to practice as a physician assistant.
If a PA meets the above criteria he or she may obtain a NPI and enroll with Medicare.
Supervision
PAs practice medicine with physician supervision. Medicare follows the supervision regulations established in each state. Unless required by state law or hospital regulation, physician supervisors are not required to be present on-site while PAs furnish care to Medicare patients. It is imperative, however, that a PA's physician supervisor (or his or her physician designee) be available to the PA for consultation purposes by telephone or other reliable means of communication. Unless otherwise noted, Medicare defers to state law regarding PA scope of practice and allows PAs to prescribe medication and durable medical equipment per their state laws.
Ownership Interest
Effective April 1, 2002, the Centers for Medicare and Medicaid Services (CMS) issued new Medicare Carrier Manual instructions that expand employment and practice ownership opportunities for PAs. The new policy removes a restriction on PA ownership by allowing a PA to have an ownership interest in an approved corporate entity (e.g., a professional medical corporation) that bills the Medicare program as long as the business entity is consistent with state law. Previously, CMS prevented payment to corporate entities in which a PA had any ownership interest.
