How Many Visits a Month Cover Your Collaborating-Physician Fee

How many visits cover the fee?

Divide the monthly fee by what one visit leaves in the practice. That is the whole calculation, and no table can run it for you, because neither number is published: the fee is privately negotiated between you and the physician, and the payment for a visit depends on the code you bill, the payer you bill it to, and the county you sit in.

The shape fits on a prescription pad. Monthly fee, divided by net revenue per visit, equals visits per month. Everything difficult about the question lives inside net revenue per visit, and Medicare has written down most of that half.

What the fee buys sets what you can reasonably expect back. Medicare covers a nurse practitioner's services only when the NP performs them while working in collaboration with a physician, and the regulation says the collaborating physician does not need to be present with the nurse practitioner when the services are furnished 1Ref 1Office of the Federal Register / Centers for Medicare & Medicaid Services (2026).§ 410.75 Nurse practitioners' services..The Medicare condition that an NP's services be furnished while working in collaboration with a physician, and the regulation's statement that the collaborating physician need not be present when the services are furnished.. You are buying a standing relationship and a signature, not hours on your schedule. What a collaborating physician's monthly fee buys is worth settling before you divide by it.

What one Medicare visit leaves in the practice

Less than the fee schedule suggests, and the reduction arrives in two steps. Federal regulation caps the Medicare allowed amount for a nurse practitioner's services at 85 percent of the physician fee schedule amount for the service 2Ref 2Office of the Federal Register (2026).42 CFR 414.56 — Payment for nurse practitioners' and clinical nurse specialists' services.Paragraph (c): Medicare allowed amounts for a nurse practitioner's services may not exceed 85 percent of the physician fee schedule amount, which is the ceiling applied to the collections any break-even or percentage-of-collections fee is computed on., and it states that as a ceiling rather than as a rate. CMS then pays 80 percent of the lesser of the actual charge or that 85 percent figure when the service is furnished outside a hospital or skilled nursing facility 3Ref 3Centers for Medicare & Medicaid Services (2026).Advanced Practice Registered Nurses (APRNs).CMS's own statement of what lands on an NP claim: 80 percent of the lesser of the actual charge or 85 percent of the physician PFS amount outside a hospital or SNF, plus assignment-only payment and the bar on charging a patient more than 42 CFR 424.55 permits..

But the remaining fifth is patient responsibility, so on paper it is not lost; whether it becomes cash depends on your front desk. A break-even built on the 85 percent figure alone assumes every coinsurance dollar collects; a break-even built on the 80 percent figure assumes none of it does. Your own aging report is the only thing that says where between those two you live.

One door is closed: charging the patient more. Medicare pays these services on an assignment basis only, and CMS states you cannot charge a patient more than the amounts permitted under 42 CFR 424.55, with any excess a patient pays refunded 3Ref 3Centers for Medicare & Medicaid Services (2026).Advanced Practice Registered Nurses (APRNs).CMS's own statement of what lands on an NP claim: 80 percent of the lesser of the actual charge or 85 percent of the physician PFS amount outside a hospital or SNF, plus assignment-only payment and the bar on charging a patient more than 42 CFR 424.55 permits.. The 85 percent step cannot be recovered from the patient, so it has to be recovered from volume, from code mix, or from payers that do not apply it.

Turning a code into a dollar figure

A Medicare payment is the code's relative value units, adjusted by your locality's geographic practice cost indices, multiplied by that year's conversion factor 4Ref 4Centers for Medicare & Medicaid Services (2025).Calendar Year (CY) 2026 Medicare Physician Fee Schedule Final Rule (CMS-1832-F).The RVU times GPCI times conversion-factor structure, the two final CY 2026 conversion factors ($33.57 qualifying APM and $33.40 nonqualifying APM, both up from $32.35 and both described as projected increases), and the CY 2026 addition of three add-on G-codes comparable to CoCM and BHI reported with the APCM base code.. The conversion factor is the piece that moves. For CY 2026 CMS finalized two of them, $33.57 for a qualifying APM participant and $33.40 for everyone else, both up from the current $32.35 and both presented as a projected increase 4Ref 4Centers for Medicare & Medicaid Services (2025).Calendar Year (CY) 2026 Medicare Physician Fee Schedule Final Rule (CMS-1832-F).The RVU times GPCI times conversion-factor structure, the two final CY 2026 conversion factors ($33.57 qualifying APM and $33.40 nonqualifying APM, both up from $32.35 and both described as projected increases), and the CY 2026 addition of three add-on G-codes comparable to CoCM and BHI reported with the APCM base code..

Run it once with a placeholder and the scale becomes visible. Take a visit whose total RVUs, after geographic adjustment, come to 2.0. At $33.40 that is $66.80 to a physician, $56.78 as your allowed amount after the 85 percent step, and $45.42 arriving from Medicare with $11.36 owed by the patient.

Per $1,000 of monthly fee, that is roughly 18 of those visits if the coinsurance collects in full and roughly 22 if none of it does. The 2.0 is a placeholder. Pull the real RVUs for the codes you bill most, and your locality's adjusters, from the Medicare Physician Fee Schedule look-up tool, and rerun the two lines.

Rerun them every January, because the conversion factor resets each calendar year and the code set moves with it. For CY 2026 CMS also finalized three new add-on codes comparable to the collaborative care and behavioral health integration codes when the advanced primary care management base code is reported 4Ref 4Centers for Medicare & Medicaid Services (2025).Calendar Year (CY) 2026 Medicare Physician Fee Schedule Final Rule (CMS-1832-F).The RVU times GPCI times conversion-factor structure, the two final CY 2026 conversion factors ($33.57 qualifying APM and $33.40 nonqualifying APM, both up from $32.35 and both described as projected increases), and the CY 2026 addition of three add-on G-codes comparable to CoCM and BHI reported with the APCM base code.. A behavioral health panel's break-even can shift on a code addition while the conversion factor sits still.

The inputs nobody publishes

Four numbers in this calculation have no public source, and inventing them is how a break-even comes out wrong. The fee itself is negotiated privately. Your no-show rate, your collection rate on the patient portion, and the contractual adjustments your commercial contracts impose are facts about your practice that only your own billing reports hold. Pull them from your own billing system. A benchmark does not know them.

But the fee's structure matters more here than its level, because structure changes the arithmetic rather than the answer. A flat monthly retainer makes this a division. A percentage of collections does not: it takes its cut from receipts already capped at 85 percent of the physician amount on Medicare work 2Ref 2Office of the Federal Register (2026).42 CFR 414.56 — Payment for nurse practitioners' and clinical nurse specialists' services.Paragraph (c): Medicare allowed amounts for a nurse practitioner's services may not exceed 85 percent of the physician fee schedule amount, which is the ceiling applied to the collections any break-even or percentage-of-collections fee is computed on., so no amount of volume reaches a break-even and the question becomes one about margin instead. Flat fee versus percentage collaborator pay is the fork to settle before you count visits.

If the practice does not bill insurance at all, none of the multipliers above apply. A membership or cash-pay panel replaces net revenue per visit with a monthly member fee and a panel size, which is the dpc equation, a different calculation from this one.

The 100 percent route, and why a solo practice cannot use it

There is an arrangement that pays the full physician rate, and a solo NP-owned practice with no physician inside it cannot use it. When an NP furnishes services as auxiliary personnel incident to the professional services of a supervising physician or NPP, the supervising practitioner bills and Medicare reimburses at 100 percent of the fee schedule, while incident-to services supervised by the NPP are reimbursed at 85 percent 5Ref 5Centers for Medicare & Medicaid Services (2026).Incident To Services & Supplies.The 100-percent-versus-85-percent fork: a supervising physician or NPP billing incident-to is reimbursed at 100 percent of the PFS while incident-to services supervised by an NPP pay 85 percent, and the conditions attached, including direct supervision and the physician's own prior service to the patient..

The conditions are the obstacle. Incident-to billing requires direct supervision along with the other conditions CMS attaches, including the physician's own prior personal service to the patient 5Ref 5Centers for Medicare & Medicaid Services (2026).Incident To Services & Supplies.The 100-percent-versus-85-percent fork: a supervising physician or NPP billing incident-to is reimbursed at 100 percent of the PFS while incident-to services supervised by an NPP pay 85 percent, and the conditions attached, including direct supervision and the physician's own prior service to the patient.. A collaborating physician on a monthly retainer, working from another county and not present when your services are furnished 1Ref 1Office of the Federal Register / Centers for Medicare & Medicaid Services (2026).§ 410.75 Nurse practitioners' services..The Medicare condition that an NP's services be furnished while working in collaboration with a physician, and the regulation's statement that the collaborating physician need not be present when the services are furnished., satisfies none of that. The 15 percentage points are real money, and they are not available to buy by paying a larger retainer.

Whether you may put a collaborator's number on the claim instead is a different question with a different rule, and billing under a collaborator's NPI is not what the incident-to provision describes.

The costs that sit on top of the monthly fee

The retainer is not the only line item, and the state's own charges land before your first visit does. Georgia charges a $150 non-refundable fee to file an APRN protocol agreement, paid electronically through the Licensing Gateway, and the board reports processing times currently averaging 30 business days depending on the complexity of the agreement 6Ref 6Georgia Composite Medical Board (2026).APRN Protocol Registration.Georgia's $150 non-refundable APRN protocol agreement filing fee paid through the Licensing Gateway, and the board's stated current processing time averaging 30 business days depending on the complexity of the agreement, as the one sourced fixed state cost sitting alongside the monthly fee.. That is Georgia's price and Georgia's queue. Every state sets its own, and several charge nothing at all.

Supply on the other side of the table is capped in some states, which is part of why a monthly number is what it is. Ohio requires an APRN to practice under a standard care arrangement entered into with each collaborating physician, and bars a physician from collaborating at the same time with more than five nurses in the prescribing component of their practices 7Ref 7Ohio General Assembly (2026).Section 4723.431 | Standard care arrangements..Ohio's requirement that an APRN practice under a standard care arrangement entered into with each collaborating physician, and the bar on a physician collaborating at the same time with more than five nurses in the prescribing component of their practices, as the supply-side reason a monthly fee is priced as it is in a capped state.. Where a cap like that applies, one physician's fixed cost of collaborating is spread across at most five prescribers, and the fee reflects that ceiling. For a psychiatric mental health NP the pool narrows again wherever the psychiatrist requirement for pmhnp collaborators applies, which is a question for your own board.

Budget the fee as a recurring obligation with a replacement cost attached. A collaborator who retires, moves or ends the agreement takes your break-even with them, and prescribing after a collaborator quits runs on a clock of its own. Whatever your state charges to file the arrangement, you will pay it again for the next one.

The five inputs and where each one comes from

Five numbers finish this calculation, and each has exactly one source. Four of them sit in systems you already log into. The fifth is the fee the physician quotes, and it is the only one you negotiate rather than look up. Assemble them in this order and the visit count falls out of the last line.

Multiply the RVUs by the adjusters and the conversion factor, take 85 percent, take 80 percent of that, add back the share of coinsurance you collect, and divide the monthly fee by the result. If the visit count that comes back is larger than the schedule you can staff, the fee, the code mix and the payer mix are the three things that can move, and each is a separate conversation. Bring the arithmetic to the one about the fee.