Physician Assistants (PA), Nurse Practitioners (NP), and Clinical Nurse Specialists reimbursement policy updates
Starting from May 01, 2021, the new policy update requires an Advanced Practice Health Care Provider to report services rendered within the scope of their licensure or certification, using their own NPI number. To find out more about the policy update, read along!
- Effective 05/01/21, the policy is being updated to require that an Advanced Practice Health Care Provider must report services rendered within the scope of their licensure or certification, using their own NPI number.
- Under the policy, services provided by an Advanced Practice Health Care Provider will only be eligible for consideration under the policy’s “incident to” guidelines if they are ineligible for their own NPI number.
- Unless otherwise contracted with a Medical Group Non-Physician Professional fee schedule, the policy will apply a reduction, consistent with CMS, of 15% from the applicable fee schedule or allowed amount for the reimbursement of the following Advanced Practice Health Care Providers: Physician Assistants, Nurse Practitioners, and Clinical Nurse Specialists.
