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

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 are subject to the Nurse Practitioner and Physician Assistant Services reimbursement payment reduction and will be removed from the physicians’ services exclusion section:

• Preventive Services
• Radiology Services

The following services are not subject to the NP PA reimbursement payment reduction and will be included in the physicians’ services exclusion section:

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

For specific policy details visit the reimbursement policy page.