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 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 Laboratory Screening Services
For specific policy details visit the reimbursement policy page.
Anthem Blue Cross and Blue Shield is the trade name of Blue Cross Blue Shield of Wisconsin (BCBSWI), Compcare Health Services Insurance Corporation (Compcare), and Wisconsin Collaborative Insurance Company (WCIC). BCBSWI underwrites or administers PPO and indemnity policies and underwrites the out of network benefits in POS policies offered by Compcare or WCIC; Compcare underwrites or administers HMO or POS policies; WCIC underwrites or administers Well Priority HMO or POS policies. Independent licensee(s) 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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