Reimbursement Rate

The payment for a Physician Assistant (PA), Nurse Practitioner (NP) and Clinical Nurse Specialist (CNS) is 80 percent of the lesser of either the actual charge or 85 percent of the Medicare Physicians Fee Schedule (MPFS) amount. For assistant at surgery services, payment equals 80 percent of the lesser of either the actual charge or 85 percent of the MPFS paid to a physician serving as an assistant at surgery. A physician serving as an assistant at surgery receives 16 percent of the MPFS amount. The PA, NP and CNS allowance is 85 percent of the 16 percent (13.6 percent of the MPFS amount).