Physician Extenders

PrimeWest Health covers health services provided by a physician extender under the supervision of the physician. Physician extender services are not covered unless they replace or substitute for the physician service.

Supervision of Physician Extenders (Except Physician Assistants [PAs])

The process of control and direction by which the physician accepts full professional responsibility for the supervisee, instructs the supervisee in his/her work, and oversees or directs the work of the supervisee. The process must meet the following conditions:

  1. The physician must be present, available, and on the premises more than 50 percent of the time when the supervisee is providing health services
  2. The diagnosis must be made by or reviewed, approved, and signed by the physician
  3. The plan of care for a condition other than an emergency may be developed by the supervisee but must be reviewed, approved, and signed by the physician before care is begun
  4. The supervisee may carry out the treatment, but the physician must review and countersign the record of a treatment within five working days after the treatment

Role of Physician Extenders in Long-Term Care Facilities (LTCFs)

Physician services provided by a physician extender in an LTCF must be provided under the direction of a physician who is an enrolled PrimeWest Health provider. This means the physician has authorized and is personally responsible for the physician services performed by the physician extender and has reviewed and signed the record of the service no more than five days after the service was performed.

Physician extenders may provide any service within their scope of practice and as delegated and directed by a physician.

As permitted by Minnesota Rules, licensure, and facility policy, APRNs or PAs who are not enrolled with PrimeWest Health and are not employees of the facility (but are working in collaboration with a physician) may provide the following physician services in an LTCF:

  1. Develop a written plan of care as required by Federal regulation
  2. Conduct a periodic visit as required by Federal regulations. At the option of the physician, and in accordance with facility policy, required visits (after the initial visit) may alternate between personal visits by the physician and visits by a PA or APRN.

Genetic Counselor or Geneticist

A genetic counselor or geneticist may conduct a consultation to render an opinion and/or advice.

  1. The genetic counselor or geneticist may only initiate diagnostic or therapeutic services at the request of the attending physician.
  2. Follow-up consultations may be performed if it is medically necessary to re-evaluate a member for whom an opinion previously has been rendered.
  3. Services provided by a genetic counselor must be billed using 96041 or S0265.

Use of Modifiers

Do not use modifier U7 for a minimal service E/M code, as defined in CPT, as it represents a level of service supervised by a physician but does not necessarily require his/her immediate ongoing presence.

Use modifier U7 with all other E/M codes when the physician extender provides services, unless the physician is directly involved more than 50 percent of the time that is required to provide the health service.

Do not use modifier U7 for physician extender services associated with enhanced prenatal care services for “at-risk” pregnancies. Refer to Physician and Professional Services – Covered Services.

Billing Physician Extender Services

  1. Enter the NPI of the physician who supervised the service as the rendering provider.
  2. Enter the appropriate procedure code for the level of care provided
  3. Enter the appropriate modifier.

Non-Covered Services

Services provided by personnel such as office and clerical workers, lab workers, assistants (e.g., surgical and ophthalmic), and aides are not considered physician extender services. These services are considered part of a physician’s overhead and cannot be billed separately.

 

Updated_08/29/2025