{"id":16167,"date":"2023-01-06T04:49:13","date_gmt":"2023-01-06T04:49:13","guid":{"rendered":"https:\/\/www.medicalbillersandcoders.com\/blog\/?p=16167"},"modified":"2025-04-24T11:51:44","modified_gmt":"2025-04-24T11:51:44","slug":"billing-non-physician-providers-npp","status":"publish","type":"post","link":"https:\/\/www.medicalbillersandcoders.com\/blog\/billing-non-physician-providers-npp\/","title":{"rendered":"Billing by Non-Physician Providers (NPPs)"},"content":{"rendered":"

Non-physician providers are healthcare professionals who offer medical services and are not doctors. A non-physician provider (NPP) is a healthcare provider who is not a physician but who practices in collaboration with or under the supervision of a physician. NPPs may bill payers directly, rather than billing under a physician, in certain circumstances. Examples of NPPs include physician assistants (PAs); advanced practice registered nurses (APRNs); nurse practitioners (NPs); clinical nurse specialists (CNSs); certified nurse midwives (CNMs); and certified registered nurse anesthetists (CRNAs).<\/p>\n

In addition to the general billing and coding policies addressed in the Billing and Coding<\/a> sections of this Manual, the following policies may be applicable to services furnished by NPPs. There are three main approaches for billing by Non-Physician Providers (NPPs) described below.<\/p>\n

1. Direct Billing by Non-Physician Providers<\/h2>\n

NPPs must be enrolled and receive their own national provider identifier (NPI) in order to directly bill services. Professional services rendered by certain licensed non-physician providers or NPPs may be billed directly to the Medicare program, provided that the services are within the NPP\u2019s scope of practice, as defined by State law. NPPs who are eligible for direct billing include, but are not necessarily limited to NPs, CNSs, CRNAs, and CNMs.<\/p>\n

On the other hand, most licensed and registered nurses and most technicians\u2019, are not eligible for direct billing. NPPs may be employees or independent contractors of a physician or physician group practice, for the physician or group practice to bill for their services. PAs, may not bill their services directly to Medicare. Medicare generally pays PAs, NPs, and CNSs at 80 percent of the lesser of the actual charge or 85 percent of physician payment under the MPFS.<\/p>\n

2. Incident to Billing by Non-Physician Practitioners<\/h2>\n

Under certain circumstances, services furnished by NPPs may be billed under a physician\u2019s provider number as \u2018incident to\u2019 the physician\u2019s services. A physician or other authorized practitioner (including PAs, NPs, and CNSs) may supervise certain other employees who provide services incident to the physician or other practitioner\u2019s services. The supervising physician or other supervising practitioner then bills for that incident-to-service using their NPI. Unlike direct billing, an NPP need not have his or her own provider identification number in order for services furnished by the NPP to be billed as \u2018incident to\u2019 a physician\u2019s services.<\/p>\n

NPP services performed \u2018incident to\u2019 a physician\u2019s services are eligible for 100 percent reimbursement when billed under the supervising physician\u2019s NPI, as opposed to the 85 percent payment services earned when billed under the NPP\u2019s NPI. To be covered as an \u201cincident to\u201d the services of a physician, the services must be:<\/p>\n