A new professional reimbursement policy for nurse practitioner and physician assistant services will be implemented beginning with dates of service on or after September 1, 2020. The new policy will 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 will be based upon all of the following:


  • service is considered a physician’s service
  • service is within the NP or PA provider’s scope of practice
  • payment reduction will be consistent with CMS reimbursement


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


For more information on the Nurse Practitioner and Physician Assistant Services Professional policy, visit the Reimbursement Policies page at anthem.com.



Featured In:
June 2020 Anthem Maine Provider News