Document Type
Article
Publication Date
11-2025
Publisher
Elsevier
Source Publication
Nursing Outlook
Source ISSN
0029-6554
Original Item ID
DOI: 10.1016/j.outlook.2025.102523
Abstract
Background
Nurse practitioners (NPs) increasingly deliver ambulatory care, yet state scope of practice (SoP) laws influence how their services are billed and utilized within Medicare.
Purpose
To compare Medicare reimbursement and service volume for ambulatory NPs and physicians by state SoP regulations.
Methods
We analyzed 100% of 2021 Medicare Part B claims, attributing claims to individual providers. Adjusted regression models estimated cost and service differentials by provider type and state SoP status.
Findings
NPs in full SoP states had higher Medicare cost and more services per beneficiary than those in restricted states. Among physicians, cost and service volume did not differ by SoP.
Discussion
Expanded practice authority for NPs increases access without reducing physician service delivery or reimbursement.
Conclusions
State SoP regulations shape ambulatory care delivery. Greater NP autonomy may improve system sustainability by increasing access to NP reimbursed services without shifting current physician reimbursement from Medicare.
Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.
Recommended Citation
Lee, Kathryn Ann; O'Reilly-Jacob, Monica; Nguyen, Thuy; Marriott, Deanna; Costa, Deena Kelly; Weiss, Marianne E.; and Yakusheva, Olga, "Medicare Part B Reimbursement and Service Volume Differences Between Ambulatory Nurse Practitioners and Physicians" (2025). College of Nursing Faculty Research and Publications. 1200.
https://epublications.marquette.edu/nursing_fac/1200
Comments
Published version. Nursing Outlook, Vol. 73, No. 6 (November-December 2025): 102523. DOI. © 2025 The Authors. Published by Elsevier Inc. Used with permission.
This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).