Policy Updates Reimbursement PoliciesCommercialDecember 1, 2024

Material adverse change

Reimbursement policy update: Nurse Practitioner and Physician Assistant Services — Professional

Beginning with dates of service on or after March 1, 2025, we will update the Nurse Practitioner and Physician Assistant Services — Professional reimbursement policy as indicated below.

The following services will be removed from the policy and are eligible for a payment reduction when billed by a nurse practitioner (NP) or physician assistant (PA) provider:

  • Preventive Services
  • Radiology Services

The following services will be added to the policy and will not be considered for a payment reduction when billed by a nurse practitioner (NP) or physician assistant (PA) provider:

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

Under the current reimbursement structure, the NP/PA services will not be reduced in payment, as mentioned above.

 For specific policy details, visit the reimbursement policy page.

Anthem Blue Cross and Blue Shield is the trade name of Rocky Mountain Hospital and Medical Service, Inc. HMO products underwritten by HMO Colorado, Inc., dba HMO Nevada. Independent licensee(s) of the Blue Cross Blue Shield Association. Anthem is a registered trademark of Anthem Insurance Companies, Inc.

NVBCBS-CM-072624-24

PUBLICATIONS: December 2024 Provider Newsletter