Billing Nurse Practioner Services


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I have a situation where we are sending a nurse practioner for a home visit no physician tagging along. Please clarify this is not a incident to service? Dont we need to credential with Medicare and bill under his/her or number?

Also, must the physician sign off on all orders and chart?

My understanding is she can not see the initial visit also.

Any help is appreciated.
Without the doctor in the building and available, I do not see how you could bill incident to. You would have to have the NP's own number to bill. I would check with my carrier to find out how it works in your area.
Definitely not incident-to. The physician would have to be there in the patient's home. For CMS information go to:
And then, it begins with # "60" in the document or page 13 (not the actual page, but page 13 in the view window).

If it's allowed in your state's NP scope of practice, and allowed with your carrier, she can see the initial visit, once she's credentialed. She'll create the plan of care, and she'll follow the patient. If the doctor ends up seeing her, it'll be an established patient visit for him. The doctor doesn't need to sign off on the chart notes, if it's all being billed under the NP.

You're NP should be a member of a local NP society in the state. Ask her/him to give you the phone number or website address of the society and they'll be able to direct you to your state's scope of practice. Also, check with your Medicare carrier for their rules and regulations. Until you're certain what an NP is allowed to do in your state, and through the local carrier, it may be best to not have him/her perform non-incident-to services on Medicare patient's.

Billing Nurse Practitioner Services

I concur with Kris (kforkismet). Physician must be in home with NP in order to bill incident to.

-Maryann C. Palmeter, CPC