Can a qualified non-physician practitioner (NPP) perform the initial visit in a skilled nursing facility and/or nursing facility?
The initial visit in a skilled nursing facility (SNF) and nursing facility (NF), procedure codes 99304-99306, must be performed by a physician except as otherwise permitted (42 C.F.R. 483.40 (c) (4)). The initial visit is defined as the initial comprehensive assessment visit during which a physician completes a thorough assessment, develops a plan of care and writes or verifies admitting orders for the nursing facility resident. Further, per the Long Term Care regulations at 42 CFR 483.40 (c)(4) and (e)(2), the physician may not delegate a task that the physician must personally perform. Therefore, the physician may not delegate the initial visit in a SNF (place of service 31). This also applies to the NF (place of service 32) with one exception. A qualified non physician practitioner (NPP) such as a nurse practitioner (NP), physician assistant (PA), or a clinical nurse specialist (CNS), who is not employed by the facility, may perform the initial visit when the State law permits in th