Medicare Reimbursement for NPs and CNSs


  • As a result of the budget bill, Public Law 105-33, enacted on August 5, 1997, the services of nurse practitioners and clinical nurse specialists were eligible, as of January 1, 1998, for Medicare Part B coverage and direct payment regardless of the geographic area in which they are provided.

  • This was the result of almost eight years of work by ANA to provide Medicare beneficiaries with access to the services of NPs and CNSs.

  • The bill defined covered physician's services to include services provided by an NP or a CNS which would be considered physician's services when provided by a physician.

  • Basically, this means that if the service would be covered under Medicare Part B when provided by a physician, it is covered when provided by an NP or a CNS.

  • Payments are set at 85% of what a physician would be paid for the same service under the Medicare Fee Schedule. This is basically the same as current law applying to NPs and CNSs in rural areas.

  • The law contains language excluding payment for some services if a facility or provider charges or is paid any amount for those services.

  • The law applies to Medicare Part B ("physician") services. It does not affect Medicaid, private insurance companies, or Medicare Part A services.

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