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.

Reference:

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.

About the Author

Reed Tinsley CPA

This article is written by Reed Tinsley, a Houston, TX-based CPA with over 30 years of experience advising physicians and medical practices across Texas and the United States. Reed holds certifications as a Certified Valuation Analyst (CVA), Certified Healthcare Business Consultant (CHBC), and Certified Financial Planner (CFP), specializing exclusively in the healthcare sector. He is a published author, nationally recognized speaker, and trusted advisor to physicians on accounting & tax, practice management, and financial planning. Schedule a Free Consultation.