Scope of Practice

The range of healthcare services and procedures that a licensed provider is legally authorized to perform based on their education, training, licensure, and state law.

Scope of practice defines what you are legally allowed to do as a healthcare provider. It is determined by your license type, your state's practice act, and in some cases, your specific training and certifications. Practicing outside your scope is illegal and can result in license revocation, malpractice liability, and criminal charges. Scope of practice varies significantly by provider type and by state. A physician's scope of practice is generally the broadest, limited primarily by their training and specialty competence rather than by statute. Nurse practitioners, physician assistants, psychologists, social workers, physical therapists, and other non-physician providers have scope of practice defined more specifically by state law. The scope of practice debate is most heated around NPs and PAs. Some states grant NPs full practice authority, meaning they can diagnose, treat, and prescribe independently without physician supervision. Other states require collaborative agreements or supervisory arrangements. The specific scope varies not just by state but by specialty. A psychiatric NP in a full-practice-authority state has a very different scope than a family NP in a restricted state. During credentialing, payers evaluate whether the services you plan to bill for fall within your scope of practice. If you are a psychologist billing for psychological testing and therapy, the payer verifies that your state license authorizes those services. If you are an NP requesting to credential as a primary care provider, the payer checks your state's NP scope of practice laws. Scope of practice also affects what CPT codes you can bill. If a procedure is outside your scope of practice as defined by your state license, you cannot bill for it regardless of whether you have the training. A chiropractor might have extensive training in a procedure, but if their state's chiropractic practice act does not include that procedure, they cannot perform or bill for it. Stay current on scope of practice changes in your state. Legislatures regularly update practice acts, and changes can expand or restrict what you are authorized to do. Your professional association is usually the best source for scope of practice updates.