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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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