Wiki New to nurse practitioner billing

[sbarbour3]

Can someone help me with NP billing? If we are billing the NP services as incident to, what would the CMS 1500 look like? What NPI would go in box J and box 31? If it isn't incident to, what NPI goes in box J and box 31?

 

[SharonCollachi]

Billing Instructions (click for full article)​

CMS 1500 Claim Form or Electronic Equivalent​

Claims are billed as if the physician personally rendered the services.

Item 33 of the CMS 1500 claim form or electronic equivalent = individual physician National Provider Identifier (NPI)/group NPI
Claim submitted by a group practice - Item 24J = physician’s NPI (billing for "incident to")
Name of the physician or non-physician practitioner who performs the initial service and orders the non-physician service must appear in item 17
Enter the qualifier to the left of the dotted vertical line on item 17 followed by the name
DN= Referring Provider
DK =Ordering Provider
DQ =Supervising Provider
Example item 17:

Claims for the services listed below require the name and NPI of the certifying physician or non-physician practitioner of the therapy plan of care be entered as the referring physician in Items 17 and 17b.

physical therapy
occupational therapy
speech-language pathology services (including those furnished incident to a physician or non-physician practitioner)
Example 17a and 17b:

Enter the NPI of the supervisor (when the person who ordered the service is not supervising) in the lower un-shaded portion of item 24J.

Example Item 24J:

When directly supervising the "incident to" service, enter the signature of the ordering physician or non-physician practitioner in item 31.

Not supervising the "incident to" service, enter the signature of the physician or non-physician practitioner providing the direct supervision in item 31.

Example Items 24J and 31:

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