New Reimbursement Policies: Nurse Practitioner and Physician Assistant Services (Professional)*

A new professional reimbursement policy for Nurse Practitioner, and Physician Assistant services, will be implemented beginning with dates of service on or after September 1, 2020.

 

Anthem Blue Cross and Blue Shield (Anthem) will 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 physicians’ service.
• The service is within the NP or PA provider’s scope of practice.
• A payment reduction consistent with CMS reimbursement.

 

Services furnished by the NP or PA should be submitted with their own NPI.

 

For more information about this policy, visit the Reimbursement Policies page on the anthem.com provider website for your state: Indiana, Kentucky, Missouri, Ohio, Wisconsin.

 

* Material Changes/Amendments to Contract and Changes to Prior Authorization Requirements may apply for new or updated reimbursement policies, medical policies, or prior authorization requirements

 

470-0620-PN-IN.OH.WI