Effective February 1, 2026, Independence Blue Cross (IBX) and Independence Administrators will implement a new policy outlining their position on reimbursement for advanced practice provider (APP) services. Specifically:
- Services performed by an APP, incident to a physician's services, using the physician's NPI and Modifiers SA or SB, will be reimbursed at 85 percent of the standard physician fee schedule, subject to the specific terms and conditions of the participation agreement.
- Services performed by an APP, reporting under their own NPI, will be reimbursed in accordance with the specific terms and conditions of the participation agreement.
- Covered vaccines and injectables are eligible for reimbursement consideration by IBX and Independence Administrators in accordance with the standard vaccine and injectable fee schedule.
This update supports our commitment to keeping health care affordable for members and customers.
Learn more
For more information about updated reimbursement for APP services effective February 1, 2026, please refer to the following notifications:
Note: The above policy notification links will expire and become unusable on February 1, 2026, when the new policies are issued.
To access the most updated version of any active policy, please refer to the Medical and Claim Payment Policy Portal or simply navigate to the Commercial or Medicare Advantage policy bulletins.
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