Code of Massachusetts Regulations
130 CMR - DIVISION OF MEDICAL ASSISTANCE
Title 130 CMR 433.000 - Physician Services
Section 433.434 - Physician Assistant Services

Universal Citation: 130 MA Code of Regs 130.433

Current through Register 1531, September 27, 2024

(A) General. 130 CMR 433.434 applies specifically to physician assistants. In general, however, subject to compliance with state and federal law, the requirements and limitations elsewhere in 130 CMR 433.000 that apply to physicians also apply to physician assistants, such as service and payment limitations, recordkeeping and reporting requirements, and prior-authorization and other conditions of coverage. Services provided by a physician assistant must be limited to the scope of practice authorized by state law or regulation (including but not limited to 263 CMR 5.00: Scope and Practice and Employment of Physician Assistants).

(B) Conditions of Payment. In accordance with 263 CMR: Board of Registration of Physician Assistants, the MassHealth agency does not pay physician assistants directly. The MassHealth agency pays a group practice employer of a physician assistant for physician assistant services. Physician assistant services are payable when:

(1) the services are limited to the scope of practice authorized by state law or regulation (including but not limited to 263 CMR: Board of Registration of Physician Assistants or of the state licensing agency of another state in which the services are provided);

(2) the physician assistant or group practice is not an employee of the hospital or other facility in which the physician assistant services were performed, or is not otherwise paid by the hospital or facility for the service;

(3) the services are provided pursuant to a formal supervisory arrangement with a physician, as further described in 263 CMR 5.00: Scope and Practice and Employment of Physician Assistants and 130 CMR 433.434(D);

(4) the physician assistant participates in MassHealth pursuant to the requirements of 130 CMR 433.434(C); and

(5) for an out-of-state physician assistant the requirements of 130 CMR 433.403(C) are met.

(C) Physician Assistant Provider Eligibility. Any physician assistant applying to participate as a provider in MassHealth must submit documentation, satisfactory to the MassHealth agency, that he or she

(1) is licensed to practice as a physician assistant by the Massachusetts Board of Registration of Physician Assistants or by the licensing agency of another state in which the physician assistant services are provided; and

(2) is a member of a group practice comprising at least one physician.

(D) Supervisory Arrangement Requirements.

(1) The services of a physician assistant must be performed under the supervision of a physician in accordance with 263 CMR 5.00: Scope and Practice and Employment of Physician Assistants.

(2) Physician supervision of or consultation with a physician assistant is not payable as a separate service.

Disclaimer: These regulations may not be the most recent version. Massachusetts may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply.