I have never understood why that instruction is there because it makes no sense. If a nurse is going to give an injection when a physician is not on site then you have no NPI number to bill under because you cannot bill under a physician that is not present in the office and that is not just for Medicare. See what I mean? Part of me wonders if that was put there for maybe home health nurses but I have a hard time making that work as well, but more likely it is for facilities for outpatient clinics when nurses give injections. But when the place of service is an 11 then the NPI you put in 24J must be physicially in the officewhen the procedure/service is performed.