Nurse practitioner billing services
Every nurse practitioner claim starts with one decision: bill under the NP’s own NPI, or incident-to under a physician. We make that call from the documentation and each payer’s policy, keep NP enrollments current, and code telehealth to the rules that apply on the date of service.
- Physician-led
- In-house billing team
- Works inside nearly all EHRs
- BAA before any PHI
Billing challenges for nurse practitioners
Incident-to billed where it does not apply
Medicare pays incident-to services at 100 percent of the fee schedule under the supervising physician’s NPI, but only in an office or clinic, for an established patient whose plan of care a physician started, with direct supervision and ongoing physician involvement. New patients, new problems, and hospital visits do not qualify. Billed incident-to anyway, they become overpayments.
Shared hospital visits billed under the wrong practitioner
Incident-to does not apply to services in hospitals or skilled nursing facilities. When an NP and a physician in the same group share a visit there, Medicare pays it under whoever performed the substantive portion, with modifier FS, and the record must identify both practitioners.
Enrollment gaps that deny every claim
An NP needs an NPI, a state license, Medicare enrollment with benefits reassigned to the group, and separate credentialing with each Medicaid and commercial plan. Services furnished before a payer’s effective date are not billable, and a lapsed revalidation stops payment without warning.
Payer and state rules that differ from Medicare
Medicaid programs and commercial plans set their own NP policies. Some pay NPs a reduced percentage, some do not recognize incident-to, and some require the supervising or collaborating physician on the claim. State scope-of-practice laws add another layer, and they change.
How MBSG handles it
NP billing is a routing decision made claim by claim. We make it from the note and the payer’s policy, not from habit.
- Each NP encounter checked for incident-to eligibility (setting, patient status, plan of care, supervision) before it is billed under a physician; everything else billed under the NP’s own NPI
- Shared hospital visits billed under the practitioner who performed the substantive portion, with modifier FS and both practitioners documented
- Rendering, supervising, and billing provider fields mapped per payer so claims carry the NPIs each plan expects
- Telehealth claims coded to each payer’s place-of-service and modifier rules; daily submission; denials worked through our structured denial management process
Our credentialing and payer enrollment team tracks every NP by payer through the effective date. For the full Medicare requirements, see our guide to incident-to billing rules. NPs often anchor psychiatry billing and primary care billing, and they can furnish monthly dialysis visits in nephrology billing.
Free billing health check
A review of your NP claims: incident-to versus direct billing, shared-visit documentation, and enrollment-related denials.
Phased transition
NP enrollment and reassignment verified with each payer, clearinghouse and EHR connections, and provider mapping on claims.
Ongoing revenue cycle
Daily submission, payment posting, denial work, and revalidation dates tracked. Remote engagement for practices across the US.
Your quote reflects your number of NPs and physicians, visit volume, settings (office, hospital, telehealth), payer mix, and whether you need credentialing, full revenue cycle, or billing only. Pricing is a percentage of collections. See our pricing page.
Coding detail for nurse practitioner billing
The same visit can pay at two different Medicare rates depending on how it is billed. The rules below are Medicare’s; Medicaid and commercial plans publish their own.
Billing under the NP’s own NPI
Medicare Part B covers NP services in all settings, rural and urban, when the services would be covered if a physician furnished them, the NP is authorized by the state to perform them, and the NP works in collaboration with a physician as state law defines it. Payment is 80 percent of the lesser of the actual charge or 85 percent of the physician fee schedule amount. NPs can also bill services that their own clinical staff furnish incident to the NP’s services, paid at the same 85 percent level.
Incident-to under a physician
Incident-to pays 100 percent of the fee schedule when every condition holds: office or clinic setting, a physician-initiated plan of care, an established patient and problem, direct supervision, and active physician management. Since January 1, 2026, Medicare permanently allows direct supervision through real-time audio and video (not audio-only) for most incident-to services, except services with a 010 or 090 global surgery period. Commercial plans may not follow either rule. Our incident-to vs incidental guide covers a common mix-up.
Credentialing and enrollment
Medicare requires an NP to be a registered nurse authorized by the state to practice as an NP and, for anyone first enrolled on or after January 1, 2003, nationally certified with a master’s in nursing or a DNP. Enrollment runs through PECOS or the CMS-855I, which now also records reassignment of benefits to the group; the separate CMS-855R is no longer used. Commercial plans run their own NP credentialing, often through CAQH ProView, and Medicaid enrollment is state by state. See credentialing vs payer enrollment.
State scope of practice and supervision
Some states give NPs full practice authority; others require a collaborative agreement or physician supervision, and prescribing rules vary further. We bill to the rules of the state where the service is furnished and flag claims where a payer requires the collaborating or supervising physician to appear. Your counsel or state board is the authority on scope questions.
Telehealth
NPs are permanent Medicare telehealth practitioners. Through December 31, 2027, Medicare patients can receive non-behavioral telehealth at home with no geographic restriction, and audio-only is allowed in defined cases; behavioral health telehealth at home is permanent. Medicaid and commercial telehealth policies differ, including place-of-service codes (02 or 10) and modifiers (95 or 93), so we code each claim to that payer’s current rules.
Billing rules above reference public CMS guidance; key sources reviewed 2026-10-21.
Frequently asked questions
Should our NP bill under their own NPI or incident-to?
It depends on the visit, not the provider. New patients, new problems, and hospital or facility visits go under the NP’s own NPI. Established-patient follow-ups in the office can go incident-to only when every supervision and plan-of-care condition is documented. We check each encounter before it is billed.
Do you handle NP credentialing and payer enrollment?
Yes. We prepare and track Medicare, Medicaid, and commercial enrollments for each NP, including reassignment to your group and CAQH upkeep, and confirm effective dates before claims go out.
What does the audit check for NP claims?
Your recent NP claims: incident-to versus direct billing, shared-visit documentation, provider fields on the claim, telehealth coding, and enrollment-related denials. You get a real review of where revenue is leaking, not a sales call.
Related: specialty billing programs · behavioral health billing · billing audit process · transparent pricing details · contact our team
General educational information, not legal advice or a guarantee of reimbursement. Requirements vary by payer, plan, setting and date of service.
CPT is a registered trademark of the American Medical Association.
Services for nurse practitioner practices
Medical Billing and Coding
Coding and billing in one connected workflow. Documentation problems get caught before claims go out, not after denials.
Learn moreDenial Management
Root-cause analysis and corrective action on denials. Investigation and real fixes, not resubmission alone.
Learn moreEligibility and Prior Authorization
Coverage checks and authorizations secured before the visit. Eligibility never becomes a denial after the fact.
Learn moreCredentialing and Payer Enrollment
Enrollment and revalidation handled end to end. Claims stop denying for administrative reasons, and new providers get enrolled before they see patients.
Learn moreMedical Coding Services
Coding reviews aligned to current CPT/HCPCS, ICD-10-CM, and NCCI edits, with documentation feedback for your providers.
Learn moreRevenue Cycle Management
Full-cycle oversight from scheduling to final payment, measured against clear KPIs: days in A/R, first-pass acceptance, denial rate, and net collection rate.
Learn moreOther specialties
- Ambulatory Surgery
- Anesthesia
- Behavioral Health
- Cardiology
- Chiropractic
- Dental
- Dermatology
- DME
- Emergency Department
- Endocrinology
- Gastroenterology
- Geriatrics
- Internal Medicine
- Nephrology
- Neurology
- OB/GYN
- Oncology
- Ophthalmology
- Orthopedics
- Pain Management
- Pathology
- Pediatrics
- Physical Therapy
- Podiatry
- Primary Care
- Psychiatry
- Radiology
- Rehabilitation
- Urgent Care
- Urology
Find out where your nurse practitioner revenue is leaking
Start with a free billing health check: a review of your NP claims showing exactly where billing route, shared-visit documentation, or enrollment gaps are costing you. Call +1 (307) 396-4107 or email contact@medicalbillingservicesgroup.com.