The involvement of APRNs in Medicare Part B continued to increase in 2010, according to information from the American Nurses Association Dept. of Practice and Policy based on data from the Centers for Medicare & Medicaid Services.

Approved charges for APRNs who treated Medicare patients and directly billed Medicare carriers fee-for-service increased 13.8% in 2010 over 2009. As a share of total Part B approved charges, APRNs rose to 1.8% in 2010 from 1.6% the year before.

The largest increase was for nurse practitioners, whose approved charges increased 18.4%. Approved charges also increased 8.4% for clinical nurse specialists, 8.2% for certified registered nurse anesthetists and 7.6% for certified nurse midwives.

The increase in approved charges for each of the four APRN roles thus exceeded the 4.2% aggregate increase in Part B charges across all providers.

Approved services increased for all APRN roles at a rate of 10.4%. According to the ANA, this change "suggests APRNs provided a more intensive mix of services in 2010. … Notably, CNS volume increased faster than approved charges."

The increases in approved services were 13.8% for clinical nurse specialists, 11.1% for nurse practitioners, 5.9% for certified registered nurse anesthetists and 1.4% for certified nurse midwives. These changes all were higher than the 1.1% aggregate increase in Part B charges across all providers.

The ANA noted that when 2011 statistics become available a year from now, approved charges for certified nurse midwives likely will increase by more than 50% because of an Affordable Care Act provision that raised their payments to 100% of the physician fee schedule amount from the previous rate of 65%. Approved charges for nurse practitioners and clinical nurse specialists remain at 85% of the physician fee schedule amount.