Policy Updates Reimbursement PoliciesMedicare AdvantageOctober 1, 2024

Clarification to reimbursement policy update: Nurse Practitioner and Physician Assistant Services

(Policy G-20002, effective 11/01/2024)

In the August 2024 edition of the Provider News, we announced an update to the Nurse Practitioner and Physician Assistant Services policy. To clarify, we are aligning the reimbursement policy with Centers for Medicare & Medicaid Services (CMS) guidelines to indicate which services will be eligible for a payment reduction according to the Nurse Practitioner and Physician Assistant Services reimbursement structure.

The following services were removed from the policy and are eligible for a payment reduction when billed by NP/PA provider.

    • Preventive Services
    • Radiology Services

The following physician’s services are not subject to the NP/PA reimbursement payment reduction and the services are included in the not considered for payment reduction section.

    • Drugs
    • Durable Medical Equipment Prosthetics, Orthotics, and Supplies (DMEPOS)
    • Laboratory Services and Laboratory Screening Services

For additional information, please review the Nurse Practitioner and Physician Assistant Services reimbursement policy at the provider website.

Anthem BC Health Insurance Company is the trade name of Anthem Insurance Companies, Inc. Anthem Blue Cross is the trade name of Blue Cross of California. Anthem Blue Cross, Anthem Blue Cross Life and Health Insurance Company, and Anthem BC Health Insurance Company are independent licensees of the Blue Cross Association. Anthem is a registered trademark of Anthem Insurance Companies, Inc.

CABC-CR-066683-24-CPN66373

PUBLICATIONS: October 2024 Provider Newsletter