Billing, coding and enrollment for NP-led clinics, physician groups that employ NPs, and NPs rounding in hospitals and nursing facilities.
Medicare allows a nurse practitioner 85% of the physician rate, so a 99214 billed under the NP's own NPI is worth $115.27 nationally in 2026 instead of $135.61. Bill that visit incident-to when the rules are not met and the whole payment is exposed on audit. Bill it under the NP when the rules are met and the practice gives up $20.34 a visit. Our full-service medical billing checks rendering provider, supervision and enrollment on every NP claim before it goes out.
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Nurse practitioner billing services code, submit and follow up claims for NP visits, deciding between the NP's own NPI at 85% of the Medicare physician rate and incident-to billing at 100%, and keeping NP payer enrollment current. At 38 Luxen client practices, the first-pass denial rate fell from 14.2% to 6.1% within 90 days.
Independent primary care, urgent care and psychiatric NP practices bill every claim under an NP NPI, at 85% of the physician rate for Medicare. With no physician to bill incident-to under, enrollment speed decides cash flow.
Established visits can bill incident-to under a supervising physician in the office or the patient's home. New patients, new problems and hospital visits cannot, so every NP visit needs a rendering decision.
Hospitalist NPs bill under their own NPI or as split or shared visits with modifier FS. Nursing facility NPs usually bill under their own NPI. NPs in substance abuse treatment programs bill medication management visits.
Service lines we bill for NPs: office and home visits, annual wellness visits, care management, hospital and nursing facility visits, assistant-at-surgery claims and home health certification (G0180, G0179).
Most NP revenue loss is a rendering or enrollment decision, not a coding error. Dollar figures are 2026 national Medicare Physician Fee Schedule amounts, non-facility unless noted.
| Scenario | Codes | What goes wrong | $ at stake per claim | Luxen audit finding |
|---|---|---|---|---|
| Established patient with a new problem, billed incident-to | 99214 | Must bill under the NP's NPI at 85% | $20.34 overpayment; $135.61 at risk on audit | 13% of incident-to NP visits failed the new-problem or supervision test |
| Physician on site or on live video, visit billed under the NP | 99214 | Incident-to rules met, paid at 85% | $20.34 | 19% of incident-to eligible NP visits were billed at 85% |
| Ongoing primary care follow-up | 99213 + G2211 | Complexity add-on left off | $14.76 at the NP rate | G2211 was missing on 37% of eligible Medicare follow-up visits billed by NPs |
| Hospital visit shared with a physician | 99233 with FS (facility) | Billed under the physician without the substantive portion documented | $14.78 overpayment; $98.53 at risk on audit | 11% of split/shared visits lacked substantive-portion documentation |
| New NP sees Medicare patients before enrolling | 99204 | Services more than 30 days before the effective date never pay | $150.76 per new patient visit | Claims sent before NP enrollment was active caused 16% of NP denials |
Medicare allows 85% of the physician fee schedule amount when a nurse practitioner bills under their own NPI, then pays 80% of that allowed amount (CMS; 42 CFR 414.56). Incident-to billing under the supervising physician's NPI is allowed at 100%.
| Code | Physician rate | NP own NPI (85%) | Difference |
|---|---|---|---|
| 99213 established visit | $95.19 | $80.91 | $14.28 |
| 99214 established visit | $135.61 | $115.27 | $20.34 |
| 99204 new patient (never incident-to) | $177.36 | $150.76 | $26.60 |
| G2211 add-on | $17.37 | $14.76 | $2.61 |
On a 99214 under the NP's NPI, Medicare pays $92.22 and the patient owes $23.05, which is 20% coinsurance on the $115.27 allowed amount. The 15% is a lower allowed amount, not the patient's share. Our patient billing team builds statements on that math.
Direct supervision through real-time audio and video is now permanent for applicable incident-to services, excluding audio-only and services with a 010 or 090 global period (CY 2026 fee schedule final rule; 42 CFR 410.32). A physician on a live video link can supervise an NP follow-up. One reachable only by phone cannot.
Incident-to does not exist in hospitals or skilled nursing facilities. In a hospital, an NP visit bills under the NP's own NPI or as a split or shared visit.
A split or shared visit is an E/M visit that a physician and an NP in the same group both perform in a facility setting. The claim goes under the NPI of whoever performed the substantive portion: more than 50% of total time or a substantive part of medical decision making. Critical care uses time only. Modifier FS goes on the claim, and office or nursing facility visits cannot be billed as split or shared (CMS MLN006764).
On a 99233, billing under the physician when the NP did the substantive portion is a $14.78 overpayment per visit: $98.53 billed against the $83.75 the NP visit is worth.
Nursing facility visits cannot be billed as split or shared, so NP rounds usually bill under the NP's own NPI at 85%. Incident-to is never available for a patient in a skilled nursing facility.
An NP assisting at surgery reports modifier AS only. Medicare pays 85% of the 16% assistant-at-surgery amount, which works out to 13.6% of the surgeon's fee schedule amount (CMS APRN billing guidelines).
NPs can certify eligibility for Medicare home health. Certification bills as G0180 and recertification as G0179.
An NP who is not enrolled with a payer sees patients the practice cannot bill for. Our credentialing team starts payer enrollment before the first shift.
Credentialing lapses delayed payment for 1 in 12 providers added in the prior year, and a lapsed re-credentialing held payments for a median of 47 days (Luxen billing reviews). A newly hired NP waited a median 83 days for a first commercial payment, across 57 NP-led practices (Luxen billing reviews).
UnitedHealthcare's commercial policy 2026R5009A pays 85% of the physician fee schedule for NP, PA and clinical nurse specialist services and expects claims under the NP's NPI (UnitedHealthcare). Texas Medicaid pays NPs 92% of the physician rate, but 100% for lab, X-ray and injections (TMHP manual). Indiana Medicaid requires modifier SA when an APRN's service bills under a supervising practitioner's NPI (IHCP module).
AANP rates every state as full, reduced or restricted practice (AANP). In California, AB 890 created the 103 NP, who practices in a group with at least one physician, and the 104 NP, available from January 1, 2026, who may practice independently after 4,600 hours or three full-time years as a 103 NP (California BRN).
Only visits for a problem the physician already started treating qualify. A new problem handled by the NP alone bills under the NP's NPI (Noridian incident-to guidance). On a 99214 that is a $20.34 overpayment per visit. 13% of incident-to NP visits failed the new-problem or supervision test (Luxen claim audit).
Incident-to services must be furnished in a noninstitutional setting, which excludes hospitals and skilled nursing facilities (42 CFR 410.26). A shared hospital visit bills with modifier FS under whoever did the substantive portion. 11% of split/shared visits lacked substantive-portion documentation (Luxen claim audit).
Since January 1, 2026, real-time audio and video presence meets direct supervision for applicable incident-to services, except 010 and 090 global services, and audio-only never counts (CY 2026 fee schedule final rule). Billing those visits under the NP costs $20.34 on every 99214. 19% of incident-to eligible NP visits were billed at 85% (Luxen claim audit).
Billing starts on the later of the approved application's filing date or the practice start date, with a 30-day lookback only when enrollment could not happen sooner (42 CFR 424.521). Every new patient visit outside that window loses $150.76. Claims sent before NP enrollment was active caused 16% of NP denials (Luxen claim audit).
UnitedHealthcare's commercial policy pays NP services at 85% of the physician fee schedule (policy 2026R5009A), so each remittance has to be checked against the NP rate in the contract. Underpayments against contracted rates appeared on 7.8% of paid claims (Luxen claim audit), and our denials and AR recovery team appeals them.
We run the revenue cycle from eligibility to zero balance inside the practice management system you already use. How full-service billing works.
Certified coders review charges against your documentation and payer rules before the claim goes out, so the denial is prevented rather than appealed. Medical coding.
Aged and denied claims are worked to resolution, then the upstream cause is fixed so the same claims stop coming back. Denials and AR recovery.
Benefits are verified and authorizations secured before the appointment, which is the cheapest place in the cycle to stop a denial. Eligibility and prior authorization.
Statements, balance questions and payment plans are handled by the same team that worked the claim. Patient billing.
Payer enrollment and re-credentialing are tracked through to approval, so a lapsed credential never quietly stops payment. Credentialing.
A HIPAA-trained front-office assistant working inside your EHR on calls, scheduling, intake and referrals, alongside the billing team. Medical virtual assistant.
We work inside the EHR and practice management system your NPs already chart in, with no migration.
We sign the BAA before access, then set rendering, supervising and billing NPIs per payer inside your system.
2 weeks
from a signed BAA to our team working your claims
About 3 weeks
to the first recovered payments on aged AR
20+ years
combined billing and coding experience
Luxen claim audit of 8,300 nurse practitioner claims and Luxen billing reviews of 57 NP-led practices, Jan 2025 to Jun 2026:
Claims for three newly hired nurse practitioners accumulated while payer enrollment moved through different departments. Luxen completed 12 outstanding enrollments and released $87,600 in charges that had been waiting to bill.
Practice Administrator, nurse practitioner-led primary care group
Rendering and supervising provider information was applied inconsistently across our plans. Luxen mapped the correct claim setup for each payer, reducing provider-related rejections from 13.1% to 2.9% and recovering $34,800.
Managing Partner, multi-location advanced practice clinic
Full engagements are written up in our dental practice case study and our ambulance billing case study.
Our certified coders apply these rules on every NP claim.
3% to 6% of collections
Luxen's pricing generally falls between 3% and 6% of collections, depending on claim volume, specialty, payer mix, and how much of the revenue cycle your practice hands over.
Higher-volume practices usually land toward the lower end. Smaller or more complex practices land higher because there is more work per account. There is no setup fee and no exit fee, and the agreement runs month to month with 30 days notice.
A lower fee attached to weak billing is still expensive. The number that matters is what your collections do after you hire someone.
Luxen charges 3% to 6% of collections, month to month, with no setup or exit fee.
| Service line | Monthly collections | Luxen at 3% | Luxen at 6% |
|---|---|---|---|
| Office and home visits | $70,000 | $2,100 | $4,200 |
| Annual wellness visits and care management | $15,000 | $450 | $900 |
| Hospital and nursing facility visits | $15,000 | $450 | $900 |
| Total | $100,000 | $3,000 | $6,000 |
| Cost | In-house | Luxen |
|---|---|---|
| Monthly | $7,900 (7.9% of collections) | $3,000 to $6,000 |
| Annual | $94,800 | $36,000 to $72,000 |
| When a biller leaves | Open biller roles took a median 67 days to fill | No gap in coverage |
| Terms | Salaries, benefits and software | Month to month, 30 days notice |
Fully loaded in-house billing cost 7.9% of collections for practices under $2M, across 96 practices that shared payroll data (Luxen billing reviews).
| Partner type | Rendering decision | NP enrollment | Reporting | Terms |
|---|---|---|---|---|
| In-house biller | Depends on one person | Office staff between tasks | Built by staff | Payroll and turnover |
| Generalist billing company | One default rule for every visit | Often a separate vendor | Standard aging | Often annual |
| Specialty billing company | Varies by team | Sometimes an extra fee | Varies | Varies |
| EHR vendor RCM | Set by software rules | Rarely included | Vendor platform | Bundled with software |
| Luxen | Certified coders check each visit against incident-to and split or shared rules | Tracked per payer by our credentialing team | Monthly denials and AR by rendering NPI | Month to month, 30 days notice |
Compare medical billing companies on these points before you sign.
A 30-minute look at your AR ageing, denial reasons and payer mix. You leave knowing what is recoverable, what we would work first and what it would cost.
We sign a business associate agreement before anyone touches your system. Your named team then works inside the practice management system and clearinghouse you already use. Nothing is migrated, and claims are being worked within two weeks of the signed BAA.
Aged and denied claims come first because that is revenue you have already earned. Most practices see the first recovered payments inside three weeks.
Once the backlog is moving, we take over the agreed part of the daily cycle: eligibility, coding review, submission, posting, denials and patient balances.
You know who owns your claims. The team works inside the practice management system and EHR you already run, with no migration.
Claims are coded by certified coders against your documentation and payer rules. Automation handles the repetitive checks so people spend their time on the claims that need judgment.
We sign a business associate agreement before accessing protected health information, and access is limited to the named people on your account.
We look at your AR ageing, volume, payer mix and denial profile first, then tell you what we believe is recoverable and what it would cost.
A billing company is a poor fit if you are not willing to share visibility into your billing, if the vendor uses a rotating pool of people who never learn your practice, or if it cannot explain why your claims are being denied. Be wary of anyone promising large collection increases before they have seen your AR ageing. The right partner makes your revenue cycle more visible, not less.
Yes. NPs bill the same office visit codes as physicians and choose the level by medical decision making or total time, such as moderate MDM or 30 to 39 minutes for a 99214. Under the NP's own NPI, Medicare allows 85% of the physician amount, so a 99214 is $115.27 nationally in 2026 instead of $135.61, and a 99213 is $80.91 instead of $95.19.
Luxen charges 3% to 6% of collections, month to month with 30 days notice and no setup or exit fee. A clinic collecting $100,000 a month pays $3,000 to $6,000.
Claims are being worked about 2 weeks after the BAA is signed, and first recovered payments usually arrive in about 3 weeks. We work inside your current EHR, so nothing migrates. New NP enrollments run alongside, and Medicare allows billing for services as far back as 30 days before the enrollment effective date when enrollment could not happen sooner.
Yes. We work inside athenaOne, eClinicalWorks, NextGen, Elation Health, Practice Fusion, Epic and the other systems NPs chart in, and set rendering and supervising NPI rules per payer there. For incident-to claims only the supervising physician may bill, under 42 CFR 410.26, so the EHR has to record who supervised each visit.
For Medicare office visits there is no NP modifier; the NP's own NPI on the claim identifies the service. Medicare does require modifier AS when an NP assists at surgery, paid at 13.6% of the surgeon's amount, and modifier FS on split or shared facility visits. Some Medicaid programs, such as Indiana, require modifier SA when an APRN service bills under a supervising practitioner's NPI.
Thirty minutes, no deck and no fee. We look at what is sitting past 90 days and where your denials cluster, and you leave knowing what is recoverable, what we would work first, and what it would cost.
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