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September 2, 2025

Coding Guide – Medicare Incident-to and Shared Services


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Medicare has specific rules related to billing for non-physician practitioners (NPPs). This guide will discuss billing for nurse practitioners, physician assistants, clinical nurse specialists, and certified nurse midwives.  These advance practice registered nurses (APRNs) and physician assistants are referred to as “other qualified health care professionals” by CPT®.

This guide reflects the updates in the 2023 Physician Fee Schedule Rule.

This guide will not discuss billing for physical therapists, occupational therapists, psychologists, audiologists or social workers.

Commercial payers, Medicare Advantage plans and Medicaid are not required to follow CMS’s 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.

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Relevant Search Terms: NPP; Medicare incident-to;Medicare shared; Medciare incident-to and shared services; billing incident-to; billing shared services

Last revised May 28, 2025 - Betsy Nicoletti
Tags: medicare incident-to and shared services

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Our mission is to provide up-to-date, simplified, citation driven resources that empower our members to gain confidence and authority in their coding role.

In 1988, CodingIntel.com founder Betsy Nicoletti started a Medical Services Organization for a rural hospital, supporting physician practice. She has been a self-employed consultant since 1998. She estimates that in the last 20 years her audience members number over 28,400 at in person events and webinars. She has had 2,500 meetings with clinical providers and reviewed over 43,000 medical notes. She knows what questions need answers and developed this resource to answer those questions.

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