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Work Comp Questions Answered: DME Invoices and PA Reimbursements

May 12, 2015 by Catherine Montgomery

We get a lot of questions here at DaisyBill. They come in through the website, after our webinars, and even in the buffet line at conferences. In this and subsequent posts, I’ll be answering some of the most frequently asked questions. Today’s questions come from our recent webinar on the March 1st changes to the Physician OMFS.

If a DME code has a fee schedule amount, can the carrier request an invoice?

No, a carrier cannot require an invoice for durable medical equipment as long as there is a fee schedule amount associated with the code, EXCEPT when an invoice is required by statute.

Statute 5307.1 requires proof of documented paid costs only for DMEPOS that meets the definition of a dangerous device as defined by California Business and Professions Code Section 4022.

Do physician assistants (PAs) get paid the same amount as physicians?

No, physician assistants get paid 85% of the physician fee schedule. When a physician assistant is the rendering provider a modifier is no longer required. Discounted physician assistant reimbursements are calculated based on the rendering provider's taxonomy code, which is a required element of the bill.

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