Pass-Through Billing

Pass-through billing occurs when the ordering physician, professional provider, facility, or ancillary provider requests and bills for a service, but the service is not performed by the ordering physician, professional provider, ancillary of facility provider. The performing physician, professional provider, facility or ancillary provider is required to bill for the services they render unless otherwise approved by Blue Cross and Blue Shield of Texas.

BCBSTX does not consider the following scenarios to be pass-through billing:

  1. The service of the performing physician, professional provider, facility or ancillary provider is performed at the place of service of the ordering physician or professional provider and is billed by the ordering physician or professional provider, or
  2. The service is provided by an employee of a physician, professional provider, ancillary or facility provider, i.e., physician assistant, surgical assistant, advanced practice nurse, clinical nurse specialist, certified nurse midwife and registered first assistant, who is under the direct supervision of the ordering physician or professional provider and the service is billed by the ordering physician or professional provider.
  3. The service is billed by the ordering physician or professional provider

The following modifiers should be used by the supervising physician when he/she is billing for services rendered by a Physician Assistant, Advanced Practice Nurse, Registered Nurse First Assistant or Licensed Surgical Assistant:

  • AS Modifier:

    • Append the AS modifier when non-physician practitioners (PA, APN, CRNFA or LSA) are assisting surgeons as a surgical assistant.
    • Append the modifier when the supervising physician is billing on behalf of a PA, APN, or CRNFA or LSA including that provider’s National Provider Identification (NPI) number.
    • Append modifier to PA, APN, CRNFA or LSA claim submissions when billing with their own NPI.
       
  • SA Modifier:

    • Append modifier to supervising physician claim submissions when billing on behalf of a PA, APN, or CRNFA for non-surgical services
    • Append modifier to PA’s, APN’s, or CRNFA’s claim submission when billing with their own NPI number for assisting with any other non-surgical procedures
    • Claims will be processed based on the provider’s contracting status.