When a NP or PA perform services within their scope of practice, in certain circumstances depending on location and the state laws, they may directly bill Medicare with their own provider number, they may or may not get 100% reimbursement. Also, when the CPT description states, "or other qualified healthcare professional", the facility or physician will bill the services of the NP or PA with a HCPCS modifier -AS or modifier -80 for their assistance at surgery. As long as the healthcare provider performs procedures within their scope of practice depending on what state they practice, they will be considered,"other qualified healthcare professional" no matter how the procedure is billed as long as they are qualified to perform those procedures.
For example: A PA or a NP can bill for diagnostic Psychological and Neuropsychological tests to the extent authorized under State scope of practice because diagnostic tests need not meet the "incident to" requirements. Diagnostic tests may be furnished under situations that meet the "incident to" requirements but this is not required. However, carriers must not scrutinize claims for diagnostic tests utilizing the "incident to" requirements.