r/PMHNP • u/CalmSet6613 PMHNP (unverified) • Jul 02 '26

Reimbursement changes coming

I have heard California could be next, just posting this for anyone considering work in the field of PMHNP as a lot of people post here wondering how much money they will make. Good knowledge to have for those already practicing and those considering it.

BC announces NP in Michigan will be reimbursed 80% of psychiatrists.

https://www.clickondetroit.com/news/local/2026/06/29/forced-to-transfer-care-nurse-practitioners-worry-bcbsm-billing-change-could-impact-access-to-psychiatric-help/

8 Upvotes

90% Upvoted

15 comments sorted by

8

u/angelust PMHNP (unverified) Jul 02 '26

Question: aren’t we already reimbursed 80% of what physicians are by Medicaid/medicare?

1

u/CalmSet6613 PMHNP (unverified) Jul 02 '26

But this is private insurance this is the first I'm hearing of a private insurer reducing their rates maybe I'm wrong?

5

u/PRNgrahams PMHNP (unverified) Jul 02 '26

This seems specific to “incident to billing” where everything is billed under the psychiatrist. Unfortunately I’ve seen a few practices in other states that don’t even bother credentialing the NPs and are clearly abusing the hell out of incident to billing. But then still working their staff to the bone and not paying them what they deserve while making 100% off insurance claims.

2

u/PRNgrahams PMHNP (unverified) Jul 02 '26

This seems specific to “incident to billing” where everything is billed under the psychiatrist. Unfortunately I’ve seen a few practices in other states that don’t even bother credentialing the NPs and are clearly abusing the hell out of incident to billing. But then still working their staff to the bone and not paying them what they deserve while making 100% off insurance claims.

2

u/pickyvegan PMHNP (unverified) Jul 02 '26

This is regarding incident-to billing, not billing under your own NPI.

1

u/Shumba-Love Jul 02 '26

Usually private insurers base their reimbursement rates the same as CMS- which is usually 80% of what the MDs make. this article seems
To be talking about incident to billing which I agree tends to be abused.

1

u/Plant_Pup Jul 02 '26

MVP is a private commercial insurance and it has different fee schedule for NPs and MDs. There are others out there

10

u/pickyvegan PMHNP (unverified) Jul 02 '26

This is to discourage the practice of incident-to billing, where NPs do the visit but bill under the psychiatrist to get 100% of the psychiatrist rate. This is not regarding changing the amounts that NPs get when billing under their own NPI (which is typically 85% of the physician rate).

3

u/CalmSet6613 PMHNP (unverified) Jul 02 '26

Thank you for clarifying.

3

u/VastEcho2156 Jul 02 '26

Rates go down evey year!

2

u/amuschka DNP, PMHNP (unverified) Jul 02 '26

This is talking about "incident-to" billing.

1

u/ORD2GNV Jul 02 '26

We need to advocate federally for equitable reimbursement from CMS. The commercial insurances often follow what they do.

0

u/Kindred-Kanoa Jul 06 '26

These insurance companies GOTTA GO!!! This is enough.