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Thread: Billing with NP

  1. #1
    Join Date
    Apr 2007

    Question Billing with NP

    AAPC: Back to School
    We have a NP in our clinic now. I am getting confused on if I am billing with just her name or adding her supervising doc to the claim. At what point do I add him to the claim or do I?

  2. #2


    one of our clinic have two NP & 1 MD. One of NP ll get Medicare # and will be bill under her PIN number (reimbursement will be 85% of MD's) Other NP' s charge is billed under MD's name & MD reviews & signs for her work.

  3. #3
    Join Date
    Apr 2007
    Columbia, MO


    You must be very careful about using the MD # for NP work. The incident To definition is a Medicare definition which for the most part has been adopted as policy for most other carriers. The AMA has suggested that if a carrier expresses that they do not credential an NP and you are to bill those services as incident to then you must get a written policy from that carrier that expresses that they do not follow the Medicare policy for incident to. Until you know for sure it is safer to defer to Medicare policy which means you can bill under the MD # only for follow up visits and while the physician is on site.
    The physician must have already examined the patient for the same dx and have a plan of care in the chart which includes that the patient is to return for a follow up visit. The physician you are billing under must be on site within the confines of the define office suite area.

    Debra A. Mitchell, MSPH, CPC-H

  4. #4
    Join Date
    Apr 2007
    North Carolina


    I believe what you're referring to is "incident to".

    1) To qualify as “incident to,” services must be part of your patient’s normal course of treatment, during which a physician personally performed an initial service and remains actively involved in the course of treatment.

    2) The physician does not have to be physically present in the patient’s room while these services are provided, but the provider must provide direct supervision-The provider must be present in the office suite to render assistance, if necessary.

    If it's a new patient, new problem, supervising MD is not present in the office...bill under the Mid Level and their NPI (assuming it's within their scope of practice for that state)

    Also..."Incident to" does not apply to the hospital.
    Last edited by RebeccaWoodward*; 03-24-2010 at 09:36 AM.

  5. #5

    Default Billing for np and pa

    I have a question about billing for an NP or PA in the hospital for a stress test. Is it okay to bill their services in the hospital setting for codes such as 93016 and 93018? We are trying to have the mid-levels do as much as possible at the hospital to free up our physician's time. Any ideas would be appreciated!!

  6. #6


    I spent a few hours to read reatedly CMS 's NP/PA guidlines. To my understanding facility or hospital, NP or PA to reimbursement is included to hospital global pay.
    Please correct me if I am wrong. NP w/state license and national certificate and NPI number can be reimbursed independently w/out direct superving MD? if the
    service met the criteria? For example if MD is out of town, can NP render the
    E/M and reimbursed to her/his NPI number if MD is accesible with phone or e-mail??
    Thank you for your help.

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