Advanced Practice Provider

Billing and Reimbursement
Policy Number: RP-P-009

Last Updated: Feb. 27, 2024

Physician Assistants (PA), Advanced Practice Registered Nurses (APRN) and Certified Nurse Midwives (CNMW) need to be credentialed with Blue Cross and Blue Shield of Nebraska (BCBSNE). 

Services by a PA, APRN and CNMW must be billed under the advanced practice provider’s name and rendering NPI. 

Modifier -AS

PAs, APRNs and CNMWs are to use the AS modifier when billing for assistant surgery. Physicians should continue to use the 80 modifier. BCBSNE will return claims if the appropriate modifier is not used.   

BCBSNE applies a 15% differential to the applicable physician fee schedule for covered services performed or provided by PAs, NPs, APRNs and CNMWs. All advanced practice providers are expected to bill under their own NPI for services rendered and NOT under the physician’s NPI.     

The 15% differential does not apply to the following codes, which will be reimbursed at the applicable physician fee schedule amount:

  • Radiology 
  • Pathology and Lab
  • Rx