Reimbursement Policy: Nurse Practitioner and Physician Assistant Services (Professional)

(Effective 04/24/20)

Empire BlueCross BlueShield HealthPlus 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.
• A payment is consistent with NP fees schedule rates.
• New York does not allow separate reimbursement for PA providers.

 

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

 

This article is to inform you that there is now a separate and specific professional reimbursement policy to reference for Nurse Practitioner and Physician Assistant Services.

 

For additional information, please review the Nurse Practitioner and Physician Assistant Services professional reimbursement policy at www.empireblue.com/nymedicaiddoc.

 

NYE-NU-0245-20 September 2020