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RULE §355.8281 Reimbursement Methodology for Nurse Practitioners and Clinical Nurse Specialists


Published: 2015

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(a) Covered professional services provided by a nurse
practitioner (NP) or a clinical nurse specialist (CNS) are reimbursed
the lesser of the NP's or CNS' billed charges or 92 percent of the
reimbursement for the same professional service paid to a physician
(M.D. or D.O.). The claim for reimbursement must either be:
  (1) billed under the NP's or CNS' provider number;
or
  (2) a physician claim noting that the physician was
supervising the activity of the NP or CNS and did not, on the date
the service was rendered, make a decision about the patient’s
care.