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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).

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 (PA), Advanced Practice Nurse (APN) or Registered Nurse First Assistant (RNFA):

  • AS modifier: A physician should use the AS modifier when billing on behalf of a PA, APN or RNFA, including that providers National Provider Identifier (NPI), for services provided when the PA, APN, or RNFA is acting as an assistant during the surgery. Modifier AS is to be used ONLY if the PA, APN or RNFA assists at surgery.
  • SA modifier: A supervising physician should use the SA modifier when billing on behalf of a PA, APN or RNFA for nonsurgical services. Modifier SA is to be used when the PA, APN, or RNFA is assisting with any other procedure that DOES NOT include surgery.