US · guidance
CMS Pub. 100-04, ch. 12, § 110.4
PA Billing to the A/B MAC (B)
A. PA Identification
Effective January 1, 2022, PAs must have their own “nonphysician practitioner” national
provider identification (NPI) number for billing purposes. Specialty code 97 applies for
PAs enrolled in Medicare.
B. Assignment Requirement
All claims for PA services must be made on an assignment basis. If any person or entity
(PA employer or, a provider/supplier for whom the PA furnishes services as an
independent contractor) knowingly and willfully bills the beneficiary an amount in excess
of the appropriate coinsurance and deductible, the responsible party is subject to a civil
monetary penalty not to exceed $2,000 for each such bill or request for payment.
History
(Rev. 11288; Issued: 03-04-22; Effective: 01-01-22; Implementation: 02-15-22)
Provenance
- Source
- cms.gov
- Retrieved
- 2026-08-25
- Edition
- iom-2026-08-25
- Content hash
83b0e8863bcac7cafdcd8e2249f7ae46340870860b0faa6fec234379f6ab58d6
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