carynsmith
New
Good Morning Everyone,
We all know that ARNP's/PA-C's are reimbursed by Medicare at 85% for their services off of the medicare physician fee schedule. Chapter 12 Section 120.A of the claims processing manual stipulates this as well.
"In general, NPs and CNSs are paid for covered services at 80 percent of the lesser of the actual charge or 85 percent of what a physician is paid under the Medicare Physician Fee Schedule."
What I cannot find is any documentation to support that lab services paid off of the Clinical Lab fee schedule and injectables paid off of the ASP fee schedule should be paid at 85%. My assessment is that these services (i.e. 80025 & J3001) should be reimbursed at 100% of the Medicare allowable.
Can anyone confirm or deny how ARNP's/PA-Cs are paid for their lab services as well as their injectables? Can you link me to the documentation? If no one can find any documentation, would someone mind to send a redacted eob that proves/shows the way it was paid/allowed by CMS?
Any help is appreciated.
Thank you,
Caryn Smith, CPC, CPC-H, CPMA, CRHC
We all know that ARNP's/PA-C's are reimbursed by Medicare at 85% for their services off of the medicare physician fee schedule. Chapter 12 Section 120.A of the claims processing manual stipulates this as well.
"In general, NPs and CNSs are paid for covered services at 80 percent of the lesser of the actual charge or 85 percent of what a physician is paid under the Medicare Physician Fee Schedule."
What I cannot find is any documentation to support that lab services paid off of the Clinical Lab fee schedule and injectables paid off of the ASP fee schedule should be paid at 85%. My assessment is that these services (i.e. 80025 & J3001) should be reimbursed at 100% of the Medicare allowable.
Can anyone confirm or deny how ARNP's/PA-Cs are paid for their lab services as well as their injectables? Can you link me to the documentation? If no one can find any documentation, would someone mind to send a redacted eob that proves/shows the way it was paid/allowed by CMS?
Any help is appreciated.
Thank you,
Caryn Smith, CPC, CPC-H, CPMA, CRHC