Medicare Billing Guidelines for NPs, CNS, and PAs

Medicare Billing Guidelines for Nurse Practitioners (NP), Clinical Nurse Specialists (CNS), and Physician Assistants (PA)

Medicare Billing Option #1: Direct Billing
Nurse Practitioners (NP), Clinical Nurse Specialists (CNS), and Physician Assistants (PA) may apply for individual provider numbers for direct billing purposes. All covered services rendered may be billed using the NPPs direct provider number. Review At-A-Glance Billing Guidelines for detailed information.

Medicare Billing Option #2:  "Incident to" Billing
Rather than bill directly for services provided as outlined in Option #1; an NPP may provide services "incident to" a physicians professional services and bill accordingly for those services.

Even though an NPP may be licensed under state law to perform a specific medical procedure and may be able to perform that medical procedure without physician supervision and have the service separately covered and paid by Medicare (as defined in Billing Option #1); all criteria must be met for those services to be covered as "incident to". Review Incident to Billing Criteria for detailed information.


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