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 were removed from the policy and are eligible for a payment reduction when billed by NP/PA provider.

• Preventive Services
• Radiology Services

The following physician’s services are not subject to the NP/PA reimbursement payment reduction and the services are included in the not considered for payment reduction section.

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

Under the current reimbursement structure, no payment reduction will be applied to the nurse practitioner services as mentioned above.

For additional information, please review the Nurse Practitioner and Physician Assistant Services reimbursement policy at the provider website.