Reimbursement Policy update: Nurse practitioner and physician assistant services, professional

This update is to inform you that there is now a separate and specific professional reimbursement policy to reference for Nurse Practitioner and Physician Assistant Services.

Anthem Blue Cross continues to allow reimbursement for services provided by Nurse Practitioner (NP) and Physician Assistant (PA) providers. Unless provider, state, federal or CMS contracts and/or requirements indicate otherwise, reimbursement is based upon all of the following:

• Service is considered a physician’s service
• Service is within the scope of practice
• A payment reduction consistent with CMS reimbursement

 

Services furnished by the NP or PA should be submitted with their own NPI.

 

For additional information on the Nurse Practitioner and Physician Assistant Services professional policy, visit https://mediproviders.anthem.com/ca.