Medicare 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 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.
In Missouri (excluding 30 counties in the Kansas City area): Anthem Blue Cross and Blue Shield is the trade name of RightCHOICE® Managed Care, Inc. (RIT), Healthy Alliance® Life Insurance Company (HALIC), and HMO Missouri, Inc. RIT and certain affiliates administer non-HMO benefits underwritten by HALIC and HMO benefits underwritten by HMO Missouri, Inc. RIT and certain affiliates only provide administrative services for self-funded plans and do not underwrite benefits. Independent licensees of the Blue Cross Blue Shield Association. Anthem is a registered trademark of Anthem Insurance Companies, Inc.
MULTI-BCBS-CR-066719-24-CPN66373
PUBLICATIONS: October 2024 Provider Newsletter
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