What is the reimbursement rate for services performed by NPPs that are not billed incident-to?

For services performed by Non-Physician Practitioners (NPPs) that are not billed incident-to, the reimbursement rate is set at 85% of the physician fee schedule. When NPPs, such as nurse practitioners or physician assistants, provide services independently without being billed under the supervising physician’s name (which is the incident-to billing method), their services are reimbursed at a lower rate than those billed incident-to, where full reimbursement (100%) is available.

This 85% reimbursement rate accounts for the different levels of training and the scope of practice that distinguishes NPPs from physicians. The lower rate reflects the value assigned to the services provided by NPPs in contrast to those rendered by physicians, who are recognized for their higher level of expertise and responsibilities. Thus, the scenario presented aligns accurately with the established reimbursement guidelines for non-physician services.