Non-Physician Practitioner in an ED Setting

An NPP in the ED is defined by Medicare as either a nurse practitioner (NP) or a physician assistant (PA). The DEA uses the term “midlevel’s” (MLP). Some federal agencies refer to them as advance practice provider (APP’s).

When an emergency department E/M is shared between a physician and an MLP, the service may be billed under either the physician’s or the MLP’s NPI number.

If there is no “face-to-face” portion of the E/M encounter between the patient and the physician, the service may only be billed under the MLP’s NPI number and payment will be made at 85% of the allowable.

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