CMS Pub. 100-02, ch. 9, § 40.1.3.3

Effective January 1, 2019, Medicare will pay for medically reasonable and necessary

services provided by physician assistants (PAs) to Medicare beneficiaries who have

elected the hospice benefit and who have selected a PA as their attending physician. PAs

are paid 85 percent of the fee schedule amount for their services as designated attending

physicians.

A physician assistant is defined as a professional who has graduated from an accredited

physician assistant educational program who performs such services as he or she is

legally authorized to perform (in the State in which the services are performed) in

accordance with State law (or State regulatory mechanism provided by State law) and

who meets the training, education, and experience requirements as the Secretary may

prescribe. The physician assistant qualifications for eligibility for furnishing services

under the Medicare program can be found in the regulations at 42 CFR 410.74 (c).

If a beneficiary does not have an attending physician, a nurse practitioner, or physician

assistant who has provided primary care prior to or at the time of the terminal illness, the

beneficiary may choose to be served by either a physician or a nurse practitioner who is

employed by the hospice. The beneficiary must be provided with a choice of a physician

or a nurse practitioner.

Medicare pays for attending physician services provided by physician assistants to

Medicare beneficiaries who have elected the hospice benefit and who have selected a

physician assistant as their attending physician. This applies to physician assistants

without regard to whether they are hospice employees.

Effective January 1, 2019, Medicare will pay for medically reasonable and necessary

services provided by PAs to Medicare beneficiaries who have elected the hospice benefit

and who have selected a PA as their attending physician. PAs are paid 85 percent of the

fee schedule amount for their services as designated attending physicians.

Attending physician services provided by PAs may be separately billed to Medicare only

if:

• The PA is the beneficiary's designated attending physician; and

• Services are medically reasonable and necessary; and

• Services would normally be performed by a physician in the absence of the PA,

whether or not the PA is directly employed by the hospice; and

• Services are not related to the certification of terminal illness.

If the physician assistant is employed by the hospice, the hospice can bill Part A for

physician services meeting the above criteria on a hospice claim. If the physician

assistant is not employed by the hospice, the physician assistant can bill Part B for

physician services meeting the above criteria. PAs are authorized to furnish physician

services under their State scope of practice, under the general supervision of a physician;

therefore the regulations at 42 CFR 410.150(a)(15) require that payment for PA services

may be made to the employer or contractor of a PA.

Payment for physician assistant services is made at 85 percent of the physician fee

schedule amount. Services that are duplicative of what the hospice nurse would provide

are not separately billable.

Since PAs are not physicians, as defined in 1861(r)(1) of the Act, they may not act as

medical directors or physicians of the hospice or certify the beneficiary’s terminal illness

and hospices may not contract with a PA for their attending physician services as

described in section 1861(dd)(2)(B)(i)(III) of the Act, which outlines the requirements of

the interdisciplinary group as including at least one physician, employed by or under

contract with the agency or organization. All of these provisions apply to PAs without

regard to whether they are hospice employees.

Physician assistants cannot certify or re-certify an individual as terminally ill, meaning

that the individual has a medical prognosis that his or her life expectancy is 6 months or

less if the illness runs its normal course. In the event that a beneficiary’s attending

physician is a nurse practitioner or a physician assistant, the hospice medical director or

the physician member of the hospice IDG certifies the individual as terminally ill.

The hospice face-to-face encounter must be performed by a hospice physician or hospice

nurse practitioner. PAs may not perform the face-to-face encounter.