Specialty
Nurse Practitioner Billing and RCM
The same work, reimbursed differently — and the difference comes down entirely to how the claim is filed.
Why it’s different
NP billing turns on a question most specialties never ask: whose NPI goes on the claim. Billed under the NP's own NPI, Medicare reimburses at 85% of the physician fee schedule. Billed incident-to, at 100% — but only when a specific and widely misunderstood set of supervision and plan-of-care conditions is met.
Practices lose in both directions. Filing under the NP's NPI when incident-to legitimately applied leaves money on the table. Filing incident-to when it did not is a compliance exposure, not just a billing error.
Common challenges
Where the money goes missing.
- Incident-To Conditions
- Applied to a new patient or a new problem, where it does not qualify.
- 85% vs 100%
- The reimbursement difference is never tracked, so the revenue impact stays invisible.
- Scope and Supervision
- Rules that vary by state and change what can be billed and how.
- Enrollment Delays
- Mid-level enrollment timelines that hold up billing for months after hire.
- Shared and Split Visits
- Facility-setting visits split with a physician, and the substantive-portion rules that govern them.
How we help
We check each visit against the incident-to conditions before it is filed, flag the ones that don't qualify, and report the reimbursement impact so the choice is visible rather than accidental.
We do not provide coders. Your clinical team assigns the codes. We verify and validate them.
Key codes
- CPT 99202–99215
- CPT 99381–99397
- Place of Service 11 vs 22
- Modifier 25
Indicative, not exhaustive. Code sets and payer policies change.
Get a Nurse Practitioner Billing Analysis
Send us a sample of your denials. We'll tell you what's actually driving them in your specialty.