According to Anthem BCBS (NY) starting for any DOS 11/1/24- the PA/NP will be updated to align with CMS guidelines.
Please note the following services will be eligible to be performed by the PAs/NPs and reimbursement reduction will apply:
– Preventative care services
-Radiology services
Services that are not going to be reimbursed separately:
-Drugs
-Durable Medical Equipment Prosthetics, Orthotics, and Supplies (DMEPOS)
-Laboratory Services and Laboratory Screening Services
Billing: PA/NP has to bill with their own TIN and NPI number.
For the full policy please click here:https://www.anthembluecross.com/provider/policies/reimbursement/
CMS payment for NP/PA services:
-NP services: 85% of Physician Fee for outside of hospital setting or SNF, or 80% of lesser billed charge
-NP services : incident to services done by auxiliary personnel outside hospital or SNF setting – 85% of Physician Fee Schedule
-PA services: 85% of PFS- physician fee schedule.
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