Table 1.
Summary of APP Billing and Coding
| Type of Service | Appropriate Site(s) of Service | Billable NPI | Medicare Reimbursement Levela |
|---|---|---|---|
| Independent | All inpatient and outpatient settings | APP | 85%b |
| Shared/split | Hospital inpatient/outpatient and emergency department settings (not a procedure or critical care) | MD | 100% |
| Delegated (incident-to) | Nonhospital office or clinic setting (established patients only) | MD | 100% |
APP, advanced practice provider; MD, medical doctor; NPI, National Provider Identifier.
a
Refers to the percent of the Medicare Physician Fee Schedule that Medicare will reimburse.
b
Some commercial payers reimburse APP services at 100% of the physician level, although it varies by region and payer.