American Academy of PAs Responds to MedPAC’s Report on Medicare and the Health Care Delivery System

ALEXANDRIA, Va. (June 17, 2019)—Last week the Medicare Payment Advisory Commission (MedPAC) released its June 2019 Report to the Congress: Medicare and the Health Care Delivery System, which included a recommendation to eliminate “incident to” billing for PAs (physicians assistants) and advanced practice registered nurses (APRNs) under the Medicare program.

“Incident to” is a Medicare billing provision that allows a patient seen exclusively by a PA to be billed under the physician’s name if certain strict criteria are met.

The following statement from Jonathan E. Sobel, DMSc, MBA, PA-C, DFAAPA, FAPACVS, president and chair of the AAPA Board of Directors, represents the position of the American Academy of PAs:

“Transparency in health care is essential to ensure that data and information provided to patients, health professionals, policymakers, and researchers is accurate and actionable. We urge Congress to give thorough consideration to MedPAC’s recommendation and to take action to ensure ‘incident to’ billing does not continue to hide the volume, types, or quality of medical services PAs deliver to patients.

“PAs are a ready solution for addressing health care shortages throughout the country, often serving as patients’ principal health care providers. If adopted, this recommendation will increase Medicare beneficiaries’ reliance on PAs as providers of health care services. Congress should use budgetary savings from enacting the recommendation to ensure patients relying on care provided by PAs have timely access to needed health care services. Congress should also review the Medicare reimbursement rate for PAs to ensure PAs receive fair and equitable payment for the high-quality services they deliver. Finally, Congress should consider the impact of changes to ‘incident to’ billing on practices in rural and underserved communities to protect their financial viability and maintain patient access to care.”

In the same June report, MedPAC recommends that PAs and APRNs be identified in Medicare claims and data gathering systems by the specialty in which they practice. Currently, PAs are listed as practicing in the specialty of “physician assistant” within the Medicare program. AAPA will review this recommendation but is committed to preserving maximum PA practice flexibility, which includes the ability to practice in more than one specialty simultaneously and being able to change specialties with minimal administrative burden.


About the American Academy of PAs
AAPA is the national membership organization for all PAs. PAs are medical professionals who diagnose illness, develop and manage treatment plans, prescribe medications, and often serve as a patient’s principal healthcare provider. Learn more about the profession at and engage through Facebook, LinkedIn, Instagram, Twitter, and Snapchat using the handle @aapaorg.