Is a nurse practitioner allowed to see Medicare patients on their own? The “incident to” guidelines state that the physician must see the patient on the first visit to establish the physician-patient relationship; from there onward, the NP can see the patient under direct supervision. Can the NP see a new patient without the doctor being present?
We will answer this question with the obvious caveat that the state licensure for the advanced practice provider (APP) must allow for the NP to see new patients and render the services provided without a physician present.
Medicare payment rules allow the NP to provide patient services without patient-physician contact on the date of service. Report the service provided and supported by documentation with the NP as rendering and billing provider (national provider identifier [NPI] for the NP) for the following evaluation/management services:
- new patient visits
- visits in which an established patient is seen for a new problem
- visits in which the treatment provided or prescribed is not a part of the treatment plan established by a physician
- services provided in the hospital or ambulatory surgery center.
These visits do not qualify for “incident to” billing.
Also by Ray Painter, MD, and Mark Painter: How to get reimbursed when using –22 modifier
For Medicare, “incident to” visits are only allowed in the office setting and should be billed under the physician NPI as billing provider for the following:
- The physician and NP both see the patient on the same date and documentation reflects that the physician was involved in the visit reconfirming findings and treatment plan for a new or established patient.
- An established patient is seen by the NP only and the treatment provided is a continuation of a treatment plan prescribed previously by a physician in the group (rendering provider is NPI of NP). The billing provider must be in the office suite at the time of this service (billing provider is NPI of physician present).
For private payers, you will need to check your contracts or payer websites for appropriate billing and make sure that the NP is properly credentialed with each plan as required.
Other services that are provided by the NP and ordered by the physician such as catheterization, injection, etc. can be reported under the “incident to” rules similar to nursing and other staff reporting.