CMS Pub. 100-04, ch. 12, § 120

Services Payment Methodology

(Rev. 2656, Issuance: 02-07-13, Effective: 02-19-13, Implementation: 02-19-13)

See chapter 15, sections 200 and 210 of the Medicare Benefit Policy Manual, pub. 100-

02, for coverage policy for NP and CNS services.

A. General Payment

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. There is a separate payment policy for paying for NP and CNS assistant-at-

surgery services. See section 120.1 of this chapter.

B. Global Surgical Payments

When a NP or CNS furnish services to a patient during a global surgical period, A/B

MACs (B) shall determine the level of NP or CNS involvement in furnishing part of the

surgeon’s global surgical package consistent with their current practice for processing

such claims. NP or CNS services furnished during a global surgical period shall be paid

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. Billing requirements and adjudication of

claims requirements for global surgeries are under chapter 12, sections 40.2 and 40.4 of

the Medicare Claims Processing Manual, Pub. 100-04.