Incident-To or Your Own NPI: The Fork in an NP-Owned Practice

Can an NP-owned practice bill incident to?

Yes, and the confusion comes from a word. Incident-to is not a physician-only benefit in the regulation. 42 CFR 410.26(a)(7) defines a practitioner as a non-physician practitioner authorized by the Act to receive payment for services incident to his or her own services, and the conditions in 410.26(b) are written throughout as a physician or other practitioner 1Ref 1Office of the Federal Register (2026).42 CFR 410.26 — Services and supplies incident to a physician's professional services.The definition of practitioner in 410.26(a)(7) that extends the incident-to benefit to non-physician practitioners, the auxiliary personnel and direct supervision standards including the audio and video presence allowance, the general supervision carve-out for behavioral health services, and 410.26(b)(5): only the supervising physician or practitioner may bill.. An NP-owned practice has an incident-to benefit of its own.

42 CFR 410.75(d) says it for nurse practitioners specifically: Medicare Part B covers services and supplies incident to the services of a nurse practitioner if the requirements of 410.26 are met 2Ref 2Centers for Medicare & Medicaid Services, Department of Health and Human Services (2026).42 CFR 410.75 — Nurse practitioners' services..Paragraph (d), which gives a nurse practitioner an incident-to benefit by cross-reference to 410.26, and paragraph (e), requiring that an NP's professional services be personally performed.. No supervising physician has to appear in that incident-to arrangement. A medical assistant, a nurse or a health coach can have their services billed under the NP's NPI when the 410.26 conditions are satisfied.

The other half of the question has a shorter answer. 42 CFR 410.75(e) requires that an NP's professional services be personally performed by the NP, with no facility or other provider paid for furnishing them 2Ref 2Centers for Medicare & Medicaid Services, Department of Health and Human Services (2026).42 CFR 410.75 — Nurse practitioners' services..Paragraph (d), which gives a nurse practitioner an incident-to benefit by cross-reference to 410.26, and paragraph (e), requiring that an NP's professional services be personally performed.. Nobody else's work leaves the office as the NP's own service.

So the practice runs two kinds of claim under one NPI. One carries the NP's own visits, personally performed. The other carries staff services furnished incident to those visits, billed by the NP as the supervising practitioner.

The 85 percent and the 100 percent are two different claims

Incident-to has two payment rates and they attach to different billers. CMS states it directly: incident-to services supervised by a non-physician practitioner pay 85 percent of what a physician gets under the Medicare Physician Fee Schedule, while an NPP who furnishes services as auxiliary personnel to a supervising physician or NPP, and whose supervisor bills them, is reimbursed at 100 percent of the fee schedule 3Ref 3Centers for Medicare & Medicaid Services (2026).Incident To Services & Supplies.CMS's own framing of the payment fork: 85 percent of the physician fee schedule for incident-to services supervised by an NPP, 100 percent where a supervising physician or NPP bills services furnished by auxiliary personnel, and the general supervision level for behavioral health and for chronic and transitional care management..

The 85 percent is regulation rather than payer discretion. 42 CFR 414.56(c) caps allowed amounts for the services of a nurse practitioner or clinical nurse specialist at 85 percent of the physician fee schedule amount, for services furnished beginning January 1, 1998 4Ref 4Centers for Medicare & Medicaid Services, Department of Health and Human Services (1998).42 CFR 414.56 — Payment for nurse practitioners' and clinical nurse specialists' services..The regulatory anchor for the 85 percent figure: allowed amounts for NP and clinical nurse specialist services may not exceed 85 percent of the physician fee schedule amount for services furnished beginning January 1, 1998, with assistant-at-surgery handled separately.. Assistant-at-surgery work is handled separately in the same section, and the text has not changed since it was published in 1998 4Ref 4Centers for Medicare & Medicaid Services, Department of Health and Human Services (1998).42 CFR 414.56 — Payment for nurse practitioners' and clinical nurse specialists' services..The regulatory anchor for the 85 percent figure: allowed amounts for NP and clinical nurse specialist services may not exceed 85 percent of the physician fee schedule amount for services furnished beginning January 1, 1998, with assistant-at-surgery handled separately..

What reaches the bank account is a step down from that again. Outside a hospital or skilled nursing facility, Medicare pays 80 percent of the lesser of the actual charge or 85 percent of the fee schedule amount for an NP's services 5Ref 5Centers for Medicare & Medicaid Services (2026).Advanced Practice Registered Nurses (APRNs).The payment arithmetic outside a hospital or SNF (80 percent of the lesser of the actual charge or 85 percent of the fee schedule amount) and CMS's instruction on which NPI belongs on the claim for personally performed versus incident-to services.. The remaining coinsurance sits with the beneficiary and whatever secondary coverage exists, and 414.56 is silent about that layer.

That 100 percent line is what most people mean when they ask this question.

What closes the 100 percent path for most NP-owned practices

A collaborating physician who signs an agreement and never sees a patient cannot carry an incident-to claim. The Medicare Benefit Policy Manual, Chapter 15, section 60.2 requires a direct, personal, professional service furnished by the physician to initiate the course of treatment of which the non-physician practitioner's service is an incidental part, plus subsequent physician services showing continuing active participation in the case 6Ref 6Centers for Medicare & Medicaid Services (2019).Medicare Benefit Policy Manual, Chapter 15 – Covered Medical and Other Health Services (Pub. 100-02) — §220.1.2, Plans of Care for Outpatient Physical Therapy, Occupational Therapy, or Speech-Language Pathology Services; §220.1.3, Certification and Recertification of Need for Treatment and Therapy Plans of Care.Chapter 15 section 60.2, requiring a personally furnished physician service to initiate the course of treatment with continuing active participation, and sections 60.1 and 60.1B on office-suite presence and why telephone availability is not direct supervision..

Presence is the second condition, and it is a physical one. Section 60.1B requires the physician to be present in the office suite and immediately available to provide assistance and direction throughout the time the service is performed. Section 60.1 states that availability by telephone, or presence somewhere in an institution, does not amount to direct supervision 6Ref 6Centers for Medicare & Medicaid Services (2019).Medicare Benefit Policy Manual, Chapter 15 – Covered Medical and Other Health Services (Pub. 100-02) — §220.1.2, Plans of Care for Outpatient Physical Therapy, Occupational Therapy, or Speech-Language Pathology Services; §220.1.3, Certification and Recertification of Need for Treatment and Therapy Plans of Care.Chapter 15 section 60.2, requiring a personally furnished physician service to initiate the course of treatment with continuing active participation, and sections 60.1 and 60.1B on office-suite presence and why telephone availability is not direct supervision.. A monthly collaboration retainer buys neither the initiating service nor the presence.

But suppose a physician did both. 42 CFR 410.26(b)(5) provides that the supervisor need not be the practitioner treating the patient more broadly, and that only the supervising physician or practitioner may bill Medicare for incident-to services 1Ref 1Office of the Federal Register (2026).42 CFR 410.26 — Services and supplies incident to a physician's professional services.The definition of practitioner in 410.26(a)(7) that extends the incident-to benefit to non-physician practitioners, the auxiliary personnel and direct supervision standards including the audio and video presence allowance, the general supervision carve-out for behavioral health services, and 410.26(b)(5): only the supervising physician or practitioner may bill.. The claim would belong to the collaborator, and the payment would follow the NPI on it.

That is the arrangement people are describing when they ask about billing under a collaborator's NPI. Getting that payment into an NP-owned entity is a separate problem with its own regulation.

A physician's claims reach an NP-owned entity only through a reassignment

Payment for a physician's service goes to the physician unless a reassignment exception applies. 42 CFR 424.80(a) prohibits reassignment generally. The two exceptions a small practice would have to fit are employment under 424.80(b)(1), and a contractual arrangement under 424.80(b)(2) in which Medicare may pay an entity enrolled in the program that bills for the supplier's services 7Ref 7Centers for Medicare & Medicaid Services, Department of Health and Human Services (2026).42 CFR 424.80 — Prohibition of reassignment of claims by suppliers..The reassignment prohibition in 424.80(a), the employment and contractual-arrangement exceptions in (b)(1) and (b)(2), and the joint and several overpayment liability that (d)(1) attaches to the contractual route.. Neither is a formality.

Liability travels with the contractual route. 424.80(d)(1) makes an enrolled entity that is paid under the (b)(2) contractual arrangement, and the supplier, jointly and severally liable for any Medicare overpayment to that entity 7Ref 7Centers for Medicare & Medicaid Services, Department of Health and Human Services (2026).42 CFR 424.80 — Prohibition of reassignment of claims by suppliers..The reassignment prohibition in 424.80(a), the employment and contractual-arrangement exceptions in (b)(1) and (b)(2), and the joint and several overpayment liability that (d)(1) attaches to the contractual route.. An arrangement built to move a collaborator's payments into the practice also moves the practice into the recovery path for those claims.

Whether an NP-owned entity may employ or contract with a physician at all is a state-law question before it is a Medicare one. Corporate practice of medicine doctrines and professional entity statutes differ by state, and they decide what the ownership structure is permitted to look like. That is a question for a health care attorney licensed where the practice sits, asked before the agreement is signed rather than after a payer asks how the arrangement works.

The same reassignment rules are what make NPI billing for 1099 moonlighting a billing question rather than a scheduling one.

What the NP's own incident-to benefit is good for

The NP's own benefit covers the staff the practice hires. Under 42 CFR 410.26, auxiliary personnel are the people whose services the supervising practitioner bills, and the default supervision standard is direct supervision. Behavioral health services furnished by auxiliary personnel are carved out of that default to general supervision, a lower standard, and that carve-out is the reason this benefit matters to a solo behavioral health practice 1Ref 1Office of the Federal Register (2026).42 CFR 410.26 — Services and supplies incident to a physician's professional services.The definition of practitioner in 410.26(a)(7) that extends the incident-to benefit to non-physician practitioners, the auxiliary personnel and direct supervision standards including the audio and video presence allowance, the general supervision carve-out for behavioral health services, and 410.26(b)(5): only the supervising physician or practitioner may bill..

Read the paragraph itself; a summary of it will not do. The definition of direct supervision in 410.26 now includes an allowance, for certain services furnished after December 31, 2025, for virtual presence by audio and video technology, and the section is amended in most physician fee schedule final rules. The text described here is current as amended through 91 FR 12079, March 12, 2026 1Ref 1Office of the Federal Register (2026).42 CFR 410.26 — Services and supplies incident to a physician's professional services.The definition of practitioner in 410.26(a)(7) that extends the incident-to benefit to non-physician practitioners, the auxiliary personnel and direct supervision standards including the audio and video presence allowance, the general supervision carve-out for behavioral health services, and 410.26(b)(5): only the supervising physician or practitioner may bill., so re-read the paragraph each January before changing how the schedule is built.

Which NPI goes in the rendering field is set by who supervised, not by who owns the practice. CMS instructs a non-physician practitioner to bill personally performed services under their own NPI, and states that where the NPP provides services incident to another physician's or NPP's services, that supervising physician or NPP must use their NPI to bill them 5Ref 5Centers for Medicare & Medicaid Services (2026).Advanced Practice Registered Nurses (APRNs).The payment arithmetic outside a hospital or SNF (80 percent of the lesser of the actual charge or 85 percent of the fee schedule amount) and CMS's instruction on which NPI belongs on the claim for personally performed versus incident-to services.. In a practice with one clinician, both roles are the same person.

Chronic care management and transitional care management sit under general supervision on the same CMS incident-to page 3Ref 3Centers for Medicare & Medicaid Services (2026).Incident To Services & Supplies.CMS's own framing of the payment fork: 85 percent of the physician fee schedule for incident-to services supervised by an NPP, 100 percent where a supervising physician or NPP bills services furnished by auxiliary personnel, and the general supervision level for behavioral health and for chronic and transitional care management.. The Medicare wellness and care-management codes carry their own staffing and supervision conditions, and they are worth reading on their own terms before staff time is scheduled against them.

Hiring changes the picture again. When the practice takes on its first NP or PA instead of an assistant, the new clinician arrives with an NPI, a scope-of-practice question of their own, and the option of enrolling and billing directly.

Medicare's rules stop at Medicare

Every rule above is a Medicare rule, and a commercial plan is free to write its own. What a plan pays an NP, and whether it recognizes incident-to billing at all, comes from that plan's published reimbursement policy and from the contract the practice signed with it. UnitedHealthcare's commercial and individual exchange policy for advanced practice health care providers is a worked example of the shape, not a rule that carries to other plans.

That policy makes direct billing under the advanced practice provider's own NPI its default, applies an 85 percent rate unless the provider contract provides otherwise, and states in its own text that a provider contract may supersede the policy 8Ref 8UnitedHealthcare (2026).Advanced Practice Health Care Provider Policy, Professional.One named payer's published commercial policy as the worked example of a non-Medicare rule: direct billing under the advanced practice provider's own NPI as the default, the 85 percent rate absent other contract terms, and the policy's own statement that a provider contract may supersede it.. It is version 2026R5009A, and its own history section dates that version to an anniversary review on September 1, 2026 8Ref 8UnitedHealthcare (2026).Advanced Practice Health Care Provider Policy, Professional.One named payer's published commercial policy as the worked example of a non-Medicare rule: direct billing under the advanced practice provider's own NPI as the default, the 85 percent rate absent other contract terms, and the policy's own statement that a provider contract may supersede it.. Payer policies are reissued on their own schedule, so confirm the version in force before a fee schedule is built on it.

Commercial incident-to rules are per-payer, which makes the lookup the work. Find the plan's advanced practice or non-physician practitioner reimbursement policy on its provider site, note the policy number and its version date, then read the contract terms that supersede it. Do that once per payer at contracting, and again at each anniversary review.

For a practice with no physician in it, the operating answer is short. Bill personally performed services under the NP's NPI, use the practice's own 410.26 benefit for staff services furnished incident to those visits, and leave the 100 percent version alone until someone in the practice can satisfy section 60.2.