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 (Anthem) 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:

• The service is considered a physician’s service.
• The service is within the scope of practice.
• Anthem does not allow direct reimbursement for NP and PA providers.

 

Services furnished by the NP or PA should be submitted by the supervising physician.

 

For additional information, please review the Nurse Practitioner and Physician Assistant Services professional reimbursement policy at https://mediproviders.anthem.com/ca.