Tip: Identifying Nurse Practitioner and Physician Assistant Services

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Feb 18, 2022

Jul 11, 2024

Included in the July 2024 data tips email.

Nurse practitioners (NP) and physician’s assistants (PA) may bill under their own NPI or that of a practicing physician depending on the employment and/or service arrangement.  It is difficult to identify services rendered by NPs or PAs when billing under the physician/clinic.  NP and PA services can be identified using procedure code modifiers or certain CPT/HCPCS codes.  Several resources are available to help the data user identify which does to use.  It is recommended that the data users/analyst review these resources in the context of their project to select the most appropriate identifying codes. Resources for Arkansas include but are not limited to:

https://secure.arkansasbluecross.com/members/report.aspx?policyNumber=2008010&viewIntro=yes (NP)

https://secure.arkansasbluecross.com/members/report.aspx?policyNumber=2008014 (PA)

https://www.aafp.org/fpm/1998/0500/p12.html

https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/Downloads/Medicare-Information-for-APRNs-AAs-PAs-Booklet-ICN-901623.pdf

https://www.medscape.com/viewarticle/926845

https://www.acep.org/administration/reimbursement/reimbursement-faqs/physician-assistants-and-nurse-practitioners--faq/#question11

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