Medicare has specific rules related to billing for non-physician practitioners (NPPs). This guide will discuss billing for nurse practitioners (NPs), physician assistants (PAs), clinical nurse specialists (CNS), and certified nurse midwives (CNM). These advanced practice registered nurses (APRNs) and PAs are referred to as “other qualified health care professionals [QHPs]” by CPT®. Many groups refer to them as Advance Practice Practitioners (APPs).

The first section of the guide is about incident to rules and the second about shared services.

This guide will use the term NPP, since it is a guide about Medicare rules and that is the term used in the CMS manual. We will not discuss billing for physical therapists, occupational therapists, psychologists, audiologists or social workers.

Commercial payers and Medicaid are not required to follow CMS’ rules regarding NPPs. Some of these payers will enroll and credential NPPs, and some will not. Medical practices need to research their own state Medicaid rules and commercial payer contracts.

NPP means: advanced practice registered nurse, nurse practitioner, clinical nurse specialist, certified nurse midwife or physician assistant

Additional resources for incident to and shared services can be found under How Physician Services are Paid and, in Everyday Coding.