New Medicare Patient


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We had a new Medicare patient scheduled to see a physician, however he was in surgery longer than expected and the patient saw a Nurse Practitioner. I was wondering, is this billable to Medicare? I have seen some websites say yes and others say no. I've also saw some sties that said no and then later on talked about a NP seeing a new Medicare patient and billing it out under NP and not Physician for incident to, so I'm very confused now. What makes it even more confusing to me is that the physician was doing the surgery in the hospital, however the office is in the same building as the hospital. Any advice would be appreciated.

Thank you!


True Blue
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Yes, Medicare allows NPs to bill new patient codes, so that should not be a problem. The information you saw stating that new patient visits may never be billed as 'incident to' services is correct and you can only bill under the provider who actually saw the patient, but there is no general restriction that I'm aware of that the NP cannot bill for seeing a new patient. I have heard that a few payers place restrictions on new patient codes billed by mid-level providers, but I've never actually encountered any issues with this.


True Blue
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Fully agree with Thomas here. I have seen many billers/coders confuse the idea of you cannot bill the new NPP visit under the MD as incident to vs. an NPP cannot see a new patient. I am unaware of any state's scope of practice that would restrict an NPP from seeing a new patient. It simply needs to be billed under the NPP.
I will also note I have seen practices that do not credential their NPPs with insurances, which can create a host of billing issues such as this. All providers should be credentialed. I have not heard of any restriction by payors for new patient codes on NPP claims.