We require that nurse practitioners in contracted provider offices have a collaborating agreement on file. Additionally, we recommend that physicians observe the following practices when working with nurse practitioners to help manage patient care:
New Patients
- Schedule an initial one-on-one appointment with the patient on the first visit
- Establish the patient’s plan of care
Existing Patients
- Engage in a one-on-one appointment with the patient after any new significant diagnosis
- Conduct an annual visit to review and update the patient’s plan of care
How to Bill for Nurse Practitioner Visits
To help ensure your office receives the proper payment for services provided by nurse practitioners with whom the physicians in your office have a collaborating agreement, please bill for nurse practitioner services according to the following guidelines:
| Bill As | Using | If the Nurse Practitioner Sees… |
| Stand-Alone Visit | The nurse practitioner’s NPI | A new or current patient when the physician is not in the office suite at the time of the visit
A new patient in the office and the patient has not yet had a face-to-face encounter with or plan of care developed by the physician A current patient in the office and the patient has a new diagnosis but has not yet had a face-to-face encounter with the physician about the new diagnosis A new or current patient in another health care setting and the physician does not have a face-to-face encounter with the patient on the same date of service |
| Shared or Split Visit | Either the nurse practitioner’s or physician’s NPI | A patient in addition to the physician seeing the patient (the patient has a face-to-face encounter with both the nurse practitioner and the physician) in an office setting or another health care setting, on the same date of service and each performs a substantial portion of the visit |
| Incident to | The physician’s NPI | A current patient who met with the physician face-to-face on the first visit; the patient already has a plan of care developed by the physician; the patient has no new diagnoses during the visit; and the physician is in the office suite at the time of the visit |