Nurse Practitioner and Physician Assistant Services, Reimbursement Policy
Policy governing reimbursement for services provided by nurse practitioners (NPs) and physician assistants (PAs) for Anthem HealthKeepers/HealthKeepers Plus Medicaid products in Virginia, including billing and circumstances where payment reduction does not apply.
Moved services not eligible for payment reduction to a stand-alone statement and added Laboratory to screening tests.
Removed Preventive and Radiology services from the policy and updated durable medical equipment terminology to Durable medical equipment Prosthetics, Orthotics, and Supplies (DMEPOS).
Removed definition of SA modifier and added language for clarity under Physician Services.
Reimbursement Criteria for NP and PA Services
Reimbursement criteria for NP/PA services
HealthKeepers, Inc. allows reimbursement for services provided by NP and PA providers when the following criteria are met:
ALL of the following
- The service is considered a physician's service
- The service is within the scope of practice
- A payment is consistent with the physician's contracted rates
Physician services excluded from payment reduction
- Drugs
Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.