Which Medicare Wellness and Care-Management Codes an NP May Bill

Can an NP bill all four under her own NPI?

Yes, all four, and the claim goes out under her own NPI. CMS's APRN guidance states that a nurse practitioner uses her own NPI to bill her services, and that Medicare pays those services on assignment 1Ref 1Centers for Medicare & Medicaid Services (2026).Advanced Practice Registered Nurses (APRNs).CMS's own statement that a nurse practitioner uses her own NPI to bill her services on assignment, and the payment arithmetic of 80% of the lesser of the actual charge or 85% of the physician fee schedule amount outside a hospital or SNF.. None of the four rules routes an NP's version of the service through a physician's number, and none of them asks for a co-signature.

What each family does ask for is a different eligibility test, written in a different document.

Underneath all four sits 42 CFR 410.75, which sets the federal conditions on any covered NP service: among them, the service would be covered if a physician furnished it, the NP is legally authorized by the state to perform it, and the NP performs it while working in collaboration with a physician 6Ref 6Office of the Federal Register / Centers for Medicare & Medicaid Services (2026).§ 410.75 Nurse practitioners' services..The federal coverage conditions on an NP's services, the collaboration condition and its definition where state law is silent, the fact that the collaborating physician need not be present or evaluate each patient, and the rule that an NP is paid only for personally performed professional services.. That third condition is federal, and a state that is silent on collaboration does not remove it 6Ref 6Office of the Federal Register / Centers for Medicare & Medicaid Services (2026).§ 410.75 Nurse practitioners' services..The federal coverage conditions on an NP's services, the collaboration condition and its definition where state law is silent, the fact that the collaborating physician need not be present or evaluate each patient, and the rule that an NP is paid only for personally performed professional services..

The Annual Wellness Visit

The Annual Wellness Visit is open to an NP by regulation. 42 CFR 410.15 defines the health professional who may furnish the visit, and that definition names a physician, or a physician assistant, nurse practitioner or clinical nurse specialist, or certain other medical professionals working under the direct supervision of a physician 2Ref 2Office of the Federal Register / Centers for Medicare & Medicaid Services (2025).42 CFR 410.15 -- Annual wellness visits providing Personalized Prevention Plan Services: Conditions for and limitations on coverage..The Annual Wellness Visit regulation's definition of the health professional who may furnish the visit, which names the nurse practitioner and confines direct physician supervision to the other-medical-professionals branch, the visit's required elements and 12-month eligibility conditions, and advance care planning as an element furnished at the beneficiary's discretion.. The supervision clause belongs to that third branch alone.

Advance care planning can go inside the visit. The regulation lists it as an element the visit may include at the discretion of the beneficiary, so an NP furnishing the wellness visit may furnish the planning discussion within it rather than only as a separate service 2Ref 2Office of the Federal Register / Centers for Medicare & Medicaid Services (2025).42 CFR 410.15 -- Annual wellness visits providing Personalized Prevention Plan Services: Conditions for and limitations on coverage..The Annual Wellness Visit regulation's definition of the health professional who may furnish the visit, which names the nurse practitioner and confines direct physician supervision to the other-medical-professionals branch, the visit's required elements and 12-month eligibility conditions, and advance care planning as an element furnished at the beneficiary's discretion.. The same section carries the visit's required elements and its 12-month eligibility conditions 2Ref 2Office of the Federal Register / Centers for Medicare & Medicaid Services (2025).42 CFR 410.15 -- Annual wellness visits providing Personalized Prevention Plan Services: Conditions for and limitations on coverage..The Annual Wellness Visit regulation's definition of the health professional who may furnish the visit, which names the nurse practitioner and confines direct physician supervision to the other-medical-professionals branch, the visit's required elements and 12-month eligibility conditions, and advance care planning as an element furnished at the beneficiary's discretion..

But the regulation does not carry the code. It says who may furnish the visit and what the visit has to contain; the HCPCS code and the payment amount live in the fee schedule, which is republished every year. Pull the current code and amount from the Medicare Physician Fee Schedule Look-Up Tool for your locality before you build the visit into a template.

Chronic care management, and the staff time inside it

Chronic care management names the nurse practitioner in its list of who may bill. CMS's June 2025 booklet lists physicians, certified nurse-midwives, clinical nurse specialists and nurse practitioners, and attaches no co-signature or supervision condition to the billing practitioner 3Ref 3Centers for Medicare & Medicaid Services, Medicare Learning Network (2025).Chronic Care Management Services.The list of practitioners who may bill chronic care management, nurse practitioners included; the two-or-more-chronic-conditions threshold and its risk branch; the initiating-visit requirement; the general-supervision standard for the clinical-staff codes 99487, 99489, 99490 and 99439; and the bundled Advanced Primary Care Management codes G0556, G0557 and G0558.. The patient qualifies on two or more chronic conditions expected to last at least 12 months or until death 3Ref 3Centers for Medicare & Medicaid Services, Medicare Learning Network (2025).Chronic Care Management Services.The list of practitioners who may bill chronic care management, nurse practitioners included; the two-or-more-chronic-conditions threshold and its risk branch; the initiating-visit requirement; the general-supervision standard for the clinical-staff codes 99487, 99489, 99490 and 99439; and the bundled Advanced Primary Care Management codes G0556, G0557 and G0558..

That threshold has a second branch: conditions placing the patient at significant risk of death, acute exacerbation or decompensation, or functional decline 3Ref 3Centers for Medicare & Medicaid Services, Medicare Learning Network (2025).Chronic Care Management Services.The list of practitioners who may bill chronic care management, nurse practitioners included; the two-or-more-chronic-conditions threshold and its risk branch; the initiating-visit requirement; the general-supervision standard for the clinical-staff codes 99487, 99489, 99490 and 99439; and the bundled Advanced Primary Care Management codes G0556, G0557 and G0558.. Before care-management time starts, CMS requires an initiating visit for new patients and for patients not seen within the previous year 3Ref 3Centers for Medicare & Medicaid Services, Medicare Learning Network (2025).Chronic Care Management Services.The list of practitioners who may bill chronic care management, nurse practitioners included; the two-or-more-chronic-conditions threshold and its risk branch; the initiating-visit requirement; the general-supervision standard for the clinical-staff codes 99487, 99489, 99490 and 99439; and the bundled Advanced Primary Care Management codes G0556, G0557 and G0558.. For an established panel seen inside the year, that visit is already behind you.

The clinical-staff codes are where the own-NPI question turns into a supervision question. CMS assigns 99487, 99489, 99490 and 99439 general supervision, meaning the billing practitioner does not personally provide the service but it is done under their overall direction and control 3Ref 3Centers for Medicare & Medicaid Services, Medicare Learning Network (2025).Chronic Care Management Services.The list of practitioners who may bill chronic care management, nurse practitioners included; the two-or-more-chronic-conditions threshold and its risk branch; the initiating-visit requirement; the general-supervision standard for the clinical-staff codes 99487, 99489, 99490 and 99439; and the bundled Advanced Primary Care Management codes G0556, G0557 and G0558.. An NP holds that direction herself.

Advanced primary care management is the adjacent option. G0556, G0557 and G0558 bundle principal care management, transitional care management, chronic care management, interprofessional consultations and online digital evaluation and management into a code billed once per calendar month, with no minutes to count 3Ref 3Centers for Medicare & Medicaid Services, Medicare Learning Network (2025).Chronic Care Management Services.The list of practitioners who may bill chronic care management, nurse practitioners included; the two-or-more-chronic-conditions threshold and its risk branch; the initiating-visit requirement; the general-supervision standard for the clinical-staff codes 99487, 99489, 99490 and 99439; and the bundled Advanced Primary Care Management codes G0556, G0557 and G0558..

Transitional care management after a discharge

Transitional care management is open to non-physician practitioners legally authorized and qualified to provide the services in the state where they practice, which is CMS's own wording, and nurse practitioners are named among them 4Ref 4Centers for Medicare & Medicaid Services, Medicare Learning Network (2025).Transitional Care Management Services.That non-physician practitioners legally authorized in their state, nurse practitioners among them, may provide and bill transitional care management; the 2-business-day interactive contact and the 14- and 7-calendar-day face-to-face clocks on 99495 and 99496; and the one-practitioner-per-30-day-period rule.. The condition attaches to state authorization rather than to a physician's involvement. Only one physician or non-physician practitioner may report the service for a given 30-day period 4Ref 4Centers for Medicare & Medicaid Services, Medicare Learning Network (2025).Transitional Care Management Services.That non-physician practitioners legally authorized in their state, nurse practitioners among them, may provide and bill transitional care management; the 2-business-day interactive contact and the 14- and 7-calendar-day face-to-face clocks on 99495 and 99496; and the one-practitioner-per-30-day-period rule..

TCM 99495/99496 both run on two clocks. Interactive contact with the patient or caregiver, by direct contact, telephone or electronic means, is due within 2 business days of discharge, and the required face-to-face visit falls within 14 calendar days for 99495 at moderate medical decision-making, or 7 calendar days for 99496 at high 4Ref 4Centers for Medicare & Medicaid Services, Medicare Learning Network (2025).Transitional Care Management Services.That non-physician practitioners legally authorized in their state, nurse practitioners among them, may provide and bill transitional care management; the 2-business-day interactive contact and the 14- and 7-calendar-day face-to-face clocks on 99495 and 99496; and the one-practitioner-per-30-day-period rule..

Calendar the 2-business-day contact from the discharge date rather than from the day the discharge summary reaches you, and confirm with the discharging service that nobody else has opened the period.

Remote monitoring, where eligibility is an E/M test

Remote monitoring eligibility is written as a test rather than a list. Only physicians and non-physician practitioners eligible to provide evaluation and management services can bill remote monitoring services, in CMS's own words, and an NP passes that test 5Ref 5Centers for Medicare & Medicaid Services, Medicare Learning Network (2025).Telehealth & Remote Monitoring.That remote monitoring eligibility is written as an evaluation-and-management test rather than a profession list; the established-relationship and consent conditions and the 2-15 or 16+ day data-collection counts for remote physiologic monitoring, which do not reach 98980, 98981, 99457 and 99458; the one-billing-practitioner-per-30-days rule; and that the booklet sets out which care-management services may be billed concurrently.. As with transitional care management, only one practitioner may bill remote monitoring for a patient in a 30-day period 5Ref 5Centers for Medicare & Medicaid Services, Medicare Learning Network (2025).Telehealth & Remote Monitoring.That remote monitoring eligibility is written as an evaluation-and-management test rather than a profession list; the established-relationship and consent conditions and the 2-15 or 16+ day data-collection counts for remote physiologic monitoring, which do not reach 98980, 98981, 99457 and 99458; the one-billing-practitioner-per-30-days rule; and that the booklet sets out which care-management services may be billed concurrently..

Remote physiologic monitoring carries conditions that remote therapeutic monitoring does not. It needs an established patient relationship and the patient's consent at the time the service is provided, and it needs data collected on 2 to 15 days, or on 16 or more days, out of 30, depending on which code descriptor you are billing 5Ref 5Centers for Medicare & Medicaid Services, Medicare Learning Network (2025).Telehealth & Remote Monitoring.That remote monitoring eligibility is written as an evaluation-and-management test rather than a profession list; the established-relationship and consent conditions and the 2-15 or 16+ day data-collection counts for remote physiologic monitoring, which do not reach 98980, 98981, 99457 and 99458; the one-billing-practitioner-per-30-days rule; and that the booklet sets out which care-management services may be billed concurrently.. Those day counts do not reach the treatment-management codes 98980, 98981, 99457 and 99458 5Ref 5Centers for Medicare & Medicaid Services, Medicare Learning Network (2025).Telehealth & Remote Monitoring.That remote monitoring eligibility is written as an evaluation-and-management test rather than a profession list; the established-relationship and consent conditions and the 2-15 or 16+ day data-collection counts for remote physiologic monitoring, which do not reach 98980, 98981, 99457 and 99458; the one-billing-practitioner-per-30-days rule; and that the booklet sets out which care-management services may be billed concurrently..

The same booklet sets out which care-management services may be billed concurrently with monitoring 5Ref 5Centers for Medicare & Medicaid Services, Medicare Learning Network (2025).Telehealth & Remote Monitoring.That remote monitoring eligibility is written as an evaluation-and-management test rather than a profession list; the established-relationship and consent conditions and the 2-15 or 16+ day data-collection counts for remote physiologic monitoring, which do not reach 98980, 98981, 99457 and 99458; the one-billing-practitioner-per-30-days rule; and that the booklet sets out which care-management services may be billed concurrently.. Read that section before stacking chronic care management and monitoring on one patient in one month. The December 2025 booklet is the current edition, and its telehealth half moves faster than its monitoring half, so date any telehealth rule you take from it.

What the federal collaboration condition requires

The collaboration condition is federal, and it sits on top of state law rather than inside it. 42 CFR 410.75 covers an NP's services only where the NP performs them while working in collaboration with a physician 6Ref 6Office of the Federal Register / Centers for Medicare & Medicaid Services (2026).§ 410.75 Nurse practitioners' services..The federal coverage conditions on an NP's services, the collaboration condition and its definition where state law is silent, the fact that the collaborating physician need not be present or evaluate each patient, and the rule that an NP is paid only for personally performed professional services.. Where state law addresses collaboration, the state's definition governs. Where state law is silent, the regulation supplies its own: a documented relationship with one or more physicians for issues outside the NP's scope 6Ref 6Office of the Federal Register / Centers for Medicare & Medicaid Services (2026).§ 410.75 Nurse practitioners' services..The federal coverage conditions on an NP's services, the collaboration condition and its definition where state law is silent, the fact that the collaborating physician need not be present or evaluate each patient, and the rule that an NP is paid only for personally performed professional services..

The regulation is explicit about what collaboration does not require: the collaborating physician does not need to be present with the nurse practitioner when the services are furnished, and does not have to independently evaluate each patient 6Ref 6Office of the Federal Register / Centers for Medicare & Medicaid Services (2026).§ 410.75 Nurse practitioners' services..The federal coverage conditions on an NP's services, the collaboration condition and its definition where state law is silent, the fact that the collaborating physician need not be present or evaluate each patient, and the rule that an NP is paid only for personally performed professional services..

Whether your own state requires a collaborative agreement or protocol, and what one has to contain, is a separate question with a separate answer in every state. Your board of nursing and your nurse practice act are the lookup for that half.

One more line in the same section shapes every care-management claim. An NP is paid for professional services only when the services have been personally performed by her, and supervising other non-physician staff is not personal performance 6Ref 6Office of the Federal Register / Centers for Medicare & Medicaid Services (2026).§ 410.75 Nurse practitioners' services..The federal coverage conditions on an NP's services, the collaboration condition and its definition where state law is silent, the fact that the collaborating physician need not be present or evaluate each patient, and the rule that an NP is paid only for personally performed professional services.. That is why the clinical-staff chronic care management codes are built on general supervision instead: the staff time is billed as those codes contemplate, while the NP's own billable work stays the work she does herself.

What these pay under an NP's number

Medicare's allowed amount for an NP's service is capped at 85% of the physician fee schedule amount for the same service. For services furnished on or after January 1, 1998, allowed amounts for the services of a nurse practitioner may not exceed 85 percent of the physician fee schedule amount 7Ref 7Office of the Federal Register (2026).42 CFR 414.56 — Payment for nurse practitioners' and clinical nurse specialists' services.The regulatory ceiling that allowed amounts for a nurse practitioner's services furnished on or after January 1, 1998 may not exceed 85 percent of the physician fee schedule amount.. CMS applies that as 80% of the lesser of the actual charge or 85% of the physician amount, outside a hospital or skilled nursing facility 1Ref 1Centers for Medicare & Medicaid Services (2026).Advanced Practice Registered Nurses (APRNs).CMS's own statement that a nurse practitioner uses her own NPI to bill her services on assignment, and the payment arithmetic of 80% of the lesser of the actual charge or 85% of the physician fee schedule amount outside a hospital or SNF..

The ceiling is regulatory rather than administrative 7Ref 7Office of the Federal Register (2026).42 CFR 414.56 — Payment for nurse practitioners' and clinical nurse specialists' services.The regulatory ceiling that allowed amounts for a nurse practitioner's services furnished on or after January 1, 1998 may not exceed 85 percent of the physician fee schedule amount., which matters when you are modeling a panel. It attaches to the allowed amount, and the payment CMS makes is the 80% figure computed from it 1Ref 1Centers for Medicare & Medicaid Services (2026).Advanced Practice Registered Nurses (APRNs).CMS's own statement that a nurse practitioner uses her own NPI to bill her services on assignment, and the payment arithmetic of 80% of the lesser of the actual charge or 85% of the physician fee schedule amount outside a hospital or SNF..

Whose NPI a claim carries when you moonlight as a 1099 NP for another practice is a different question, and nothing in these four rules answers it.

Before the first month of either time-based family, check whether another practitioner is already billing it for that patient: transitional care management allows one practitioner per 30-day period, and remote monitoring allows one per 30 days 4Ref 4Centers for Medicare & Medicaid Services, Medicare Learning Network (2025).Transitional Care Management Services.That non-physician practitioners legally authorized in their state, nurse practitioners among them, may provide and bill transitional care management; the 2-business-day interactive contact and the 14- and 7-calendar-day face-to-face clocks on 99495 and 99496; and the one-practitioner-per-30-day-period rule.5Ref 5Centers for Medicare & Medicaid Services, Medicare Learning Network (2025).Telehealth & Remote Monitoring.That remote monitoring eligibility is written as an evaluation-and-management test rather than a profession list; the established-relationship and consent conditions and the 2-15 or 16+ day data-collection counts for remote physiologic monitoring, which do not reach 98980, 98981, 99457 and 99458; the one-billing-practitioner-per-30-days rule; and that the booklet sets out which care-management services may be billed concurrently..