Billing for CA/PAs

Clinical Assistants (CA) and Physician Assistants (PA) provide valuable supports to physicians’ practices and it’s important to know how to bill for their services. This article provides guidelines for both community-based and hospital settings.

Community-Based Settings:

In most cases, physicians may only bill for services delivered by a CA or PA if the physician is directly involved in the patient’s care during the visit. This means the physician must interact with the patient in some capacity — either by engaging in the visit or being available to address concerns.

→ Exception: Currently, immunizations and therapeutic injections are the only services that can be fully delegated to any appropriately trained staff, including nurses or medical assistants. In these cases, the physician does not need to see the patient.

→ For more details, see our article on Immunization Delegation.

Physicians should ensure they do they following when billing for a CA or PA’s services:

Receive a summary of the encounter from the CA/PA.

Provide the patient an opportunity to ask questions they may not feel comfortable asking the CA/PA.

Review the patient chart and contribute to the care plan.

You can find more information from the College of Physicians and Surgeons of Manitoba regarding your responsibilities.

Hospital Settings:

Physicians can fully delegate more services in hospital settings, and instead bill daily care/concomitant care. The only exception to this rule would be in cases of a CA/PA assessing for admissions.

Guidelines for Both Locations:

Communication and Collaboration tariffs can often be used when using phone/video/email/fax to collaborate with allied health care workers. See our billing article on Communication between providers.

What Can Be Billed?

Location	Scenario	Billable?	Notes
Community-based clinic	A CA/PA conducts a visit. The physician checks in briefly with the patient, provides the opportunity for questions, and reviews the chart.	✅ Yes	The physician was involved in the visit.
Community-based clinic	A nurse administers an immunization at a community-based clinic. The physician does not see the patient.	✅ Yes	Immunizations can be delegated fully.
Hospital	A patient is assessed for admission by a CA/PA, the physician. The physician checks in briefly with the patient, provides the opportunity for questions, and reviews the chart.	✅ Yes	Eligible for admissions only, when daily care/concomitant care is not applicable yet.

What Cannot Be Billed?

Location	Scenario	Billable?	Notes
Community-based clinic	A CA/PA sees the patient, the physician only reviews the chart afterwards.	❌ No	The physician was not involved during the visit.
Community-based clinic	A nurse conducts a full visit. The physician briefly checks in.	❌ No	Only certain duties can be delegated to nurses.
Community-based clinic	The physician waves at the patient in the waiting room. The CA/PA handles the visit.	❌ No	Casual contact does not count as clinical involvement.
Community-based clinic	A CA/PA provides a service to the patient while the physician is out of the office.	❌ No	The physician must be available during the visit.
Community-based clinic	A CA/PA provides a virtual service and follows-up with the physician afterwards.	❌ No	The physician was not involved during the visit.
Hospital	A CA/PA provides a visit on behalf of a physician.	❌ No	This is billed under daily care/concomitant care.

Doctors Manitoba is dedicated to the advancement of physician-led, team-based care. We will continue to advocate for compensation reflective of collaborative practice models.