Certified Registered Nurse Practitioner (CRNP) & Medicare critical care billing

1. Can a Certified Registered Nurse Practitioner (CRNP) and a physician bill critical care as a split/shared service?

The split/shared evaluation and management (E/M) visit applies only to selected E/M visits and settings, i.e. hospital inpatient, hospital outpatient, hospital observation, emergency department, hospital discharge, office, non-facility clinic visits, and prolonged visits associated with these E/M visit codes. A split/shared E/M visit cannot be reported in the skilled nursing facility (SNF) or nursing facility (NF) setting, and the split/shared E/M policy does not apply to Consultation Services, critical care services or procedures.


Centers for Medicare and Medicaid Services (CMS) Publication 100-4, Chapter 12, Section 30.6.13, section H *


2. Can a Certified Registered Nurse Practitioner (CRNP) bill for critical care under his/her own provider number?

A Certified Registered Nurse Practitioner (CRNP) may perform and bill critical care services, under his/her own provider number as long as the Nonphysician Practitioner (NPP) is practicing within the scope of practice and licensure requirements for that NPPs in the state in which he/she practices. Applicable collaboration and general supervision rules apply as well as billing rules.

Have questions? I’m here to help.

This field is for validation purposes and should be left unchanged.