Nurse Practitioner & PA Credentialing

Yes. NPs have been able to bill Medicare directly since the Balanced Budget Act of 1997. When billing under the NP's own Type 1 NPI, Medicare reimburses at 85% of the physician fee schedule for the same CPT code. Commercial payers vary — some credential and pay APPs directly, others require billing under a supervising physician.

Incident-to lets an APP's services bill at 100% of the physician rate, but only under strict conditions: an established patient with an existing care plan, direct physician supervision on site, and the supervising physician's NPI on the claim. New patients and new problems generally cannot be billed incident-to. The rules are heavily audited — misuse is a common compliance finding.

It affects what you can do, not whether you must be credentialed. Per the American Association of Nurse Practitioners (AANP), as of 2026 roughly 30 jurisdictions including Washington, D.C. grant NPs full practice authority; about 12 are reduced (collaborative agreement required); the rest are restricted. PAs still require a physician relationship in most states. Payers may ask for the collaborative/supervision agreement during enrollment in reduced and restricted states.

Medicare credentialing for NPs and PAs typically runs 90–120 days depending on the MAC region; commercial payers are usually 60–120 days. A complete, attested CAQH profile and the correct certification on file (ANCC, AANP, NCCPA, etc.) are the biggest accelerators.

A Type 1 NPI, active state license, national board certification, DEA registration where prescribing, malpractice coverage, an attested CAQH ProView profile, and (in reduced/restricted states) a signed collaborative or supervision agreement.