Incident-to, Split/Shared, and NPP Billing Rules for 2026: A Practical Guide

What Your Nurse Practitioners and Physician Assistants Need to Know

Nurse Practitioners and Physician Assistants continue to take on more responsibility in day-to-day patient care, and each year brings new rules that shape how they document, code, and bill for their work. With the 2026 updates coming into play, it’s important for teams to take a fresh look at what has changed and how those changes affect their current workflows.

While CMS publishes its policies in detail, many commercial insurers take their own approach. Some follow Medicare closely, others don’t. These differences matter. They affect what must be documented, who can document it, and which provider should appear on the claim. A simple misunderstanding can lead to denied claims or extra administrative work, so making sure everyone understands the rules helps avoid problems.

The CPT changes introduced in recent years continue to influence care teams. The 2021 revisions for office visits and the 2023 updates for inpatient and observation services are still being sorted out in everyday practice. Medicare’s September 2025 E/M Guide also added several new explanations on billing Critical Care services, which now require closer attention. Looking ahead, the new remote monitoring codes for 2026—especially those tied to shorter-duration services—may expand what NPPs can do, depending on how CMS and individual insurers define their roles.

If your practice hasn’t fully adapted to the newer split/shared rules or the ongoing expectations around incident-to billing, this is the right time to get aligned. These rules affect who does what portion of the visit, what needs to be documented, and how your practice decides who the billing provider should be. Getting this right helps reduce compliance risks and improves billing accuracy.

This session will walk through the 2026 updates in a straightforward way so your clinical and administrative teams know how to apply them in real-world situations.

Webinar Objectives

• Break down what’s required for incident-to services in 2026 and what the physician needs to contribute to the plan of care
• Explain what counts as substantive work under the updated split/shared rules
• Show how expectations differ between facility-based and office-based settings
• Review the new CPT monitoring codes for 2026 and how NPPs may use them
• Look at how commercial payers handle NPP services and where they differ from Medicare
• Help teams understand what each billing method requires from a documentation standpoint

Webinar Highlights

• Updated incident-to documentation and billing rules for 2026
• How to determine the billing provider for split/shared services, and what must be documented
• How provider-based billing changes the way NPPs deliver and record services
• Key Critical Care updates from the latest CMS E/M guidance
• A closer look at the 2026 remote monitoring codes and how NPPs can incorporate them
• What CMS has permanently approved for audio/video supervision, and what’s only extended through 2025
• Clear guidance on when and how NPPs may supervise residents
• A summary of AMA discussions and CPT changes that shape NPP work in 2026
• Practical examples showing how payer-specific rules can affect documentation and billing

Who Should Attend

Physicians, NPs, PAs, coding and billing staff, auditors, practice managers, compliance teams, and anyone responsible for documentation or reimbursement in office or facility settings.