What is a Physician Assistant (PA)?

A PA is a licensed medical professional trained to evaluate, diagnose, and treat patients. PAs can prescribe medications and participate in care management programs.

Can a PA bill Medicare for care management services?

Yes. Physician Assistants are Qualified Health Professionals (QHPs) under CMS and can bill for CCM, PCM, CoCM, and TCM services if properly credentialed.

Is a PA allowed to supervise clinical staff for billing purposes?

Yes. PAs may supervise nurses and other clinical staff who provide care management services, as long as CMS supervision rules are met and documentation is complete.

How does a PA compare to a Nurse Practitioner (NP)?

PAs and NPs have similar scopes of practice. PAs are trained in a medical model, while NPs are trained in the nursing model. Both can bill for care management services.

What codes can a PA bill for under CMS care management programs?

Codes include 99490 for CCM, 99424 for PCM, 99495 for TCM, and 99492 for CoCM. The PA must meet all billing and documentation requirements.

Can a PA be the billing provider in the Collaborative Care Model (CoCM)?

Yes. PAs may serve as the billing provider in CoCM, working with behavioral health staff under CMS’s Collaborative Care billing rules.

What Is an Advanced Practice Registered Nurse (APRN)?

An Advanced Practice Registered Nurse (APRN) is a licensed registered nurse who has completed advanced clinical education—typically at the master’s or doctoral level—and holds certification in a defined population focus. APRNs are trained to assess, diagnose, treat, and manage patients independently or in collaboration with other healthcare providers.

The APRN designation serves as an umbrella term that includes four distinct roles:

Nurse Practitioners (NPs)
Clinical Nurse Specialists (CNSs)
Certified Nurse Midwives (CNMs)
Certified Registered Nurse Anesthetists (CRNAs)

In the context of Medicare care management programs, APRNs are considered Qualified Health Professionals (QHPs) and are eligible to:

Bill Medicare directly for services like Chronic Care Management (CCM), Principal Care Management (PCM), Transitional Care Management (TCM), and more
Supervise clinical staff performing care coordination and documentation tasks
Lead care delivery teams across primary care, specialty clinics, and hospital systems

The APRN role is recognized by CMS and state medical boards as central to team-based care delivery—especially in practices that serve patients with complex, chronic, or high-risk conditions.

Key Functions of an Advanced Practice Registered Nurse (APRN)

APRN roles are designed to expand the reach, quality, and coordination of healthcare services across a wide range of clinical settings. Though individual functions vary by specialization, all APRNs share a foundation of advanced clinical expertise and decision-making authority.

Across care environments, APRNs often:

Diagnose and manage acute or chronic health conditions
Prescribe medications and order diagnostics within their scope of practice
Lead care management programs as billing providers under Medicare
Supervise interdisciplinary teams, including RNs, care coordinators, and support staff
Serve as continuity providers during care transitions or high-risk periods
Provide patient education, preventative counseling, and long-term treatment planning

Because APRNs blend medical knowledge with nursing principles, they’re often the backbone of chronic care delivery, especially in primary care clinics, rural practices, and specialty settings.

The Role of an APRN in Care Delivery

Advanced Practice Registered Nurses are central to delivering high-quality, patient-centered care—particularly in settings that manage chronic conditions or require multidisciplinary coordination. APRNs often serve as the anchor provider in care teams, blending diagnostic expertise with a nursing-informed approach to long-term support.

In daily clinical operations, APRNs may:

Serve as the primary provider for patients with multiple chronic conditions
Lead care management workflows, fulfilling CMS documentation and billing criteria
Coordinate across specialties and facilitate transitions of care
Deliver preventative and wellness services such as Annual Wellness Visits or Advance Care Planning
Supervise licensed staff who support care delivery, education, and follow-up
Monitor compliance, documentation, and care quality metrics for CMS programs

Because APRNs are credentialed and authorized to act independently, they’re frequently used by clinics that need to balance physician access constraints with a growing population of complex patients.

Billing and Supervision Rules for ARPNs

All four types of Advanced Practice Registered Nurses (NP, CNS, CNM, CRNA) are recognized by CMS as Qualified Health Professionals (QHPs). This designation allows them to bill Medicare directly for a wide range of time-based and service-specific codes—provided they are properly credentialed and enrolled.

Billing Capabilities:

APRNs may independently bill for:

Chronic Care Management (CCM) – CPT 99490, 99439, 99491
Principal Care Management (PCM) – CPT 99424–99427
Transitional Care Management (TCM) – CPT 99495–99496
Advance Care Planning, Annual Wellness Visits, and more
Procedure-specific services (e.g., anesthesia by CRNAs, obstetric care by CNMs)

Supervision Capabilities:

When acting as the billing provider, APRNs may:

Supervise auxiliary clinical staff (e.g., RNs, LPNs, MAs) delivering care management services
Delegate care tasks under general supervision rules (no requirement for on-site presence)
Attest to care plan development, patient eligibility, and documentation standards

Credentialing Requirements:

To bill Medicare, APRNs must:

Hold an active state license aligned with their specialty
Be nationally certified by an approved board (e.g., AANP, ANCC, NCC, NBCRNA)
Be individually enrolled in Medicare as an APRN provider type

APRNs can function as the sole billing provider in many outpatient and institutional settings—making them especially valuable for scalable, CMS-compliant chronic care programs.

Types of APRNs and Their Roles

The APRN designation includes four nationally recognized specialties, each certified to serve different patient populations and care contexts. While they share a regulatory foundation, each type of APRN offers a distinct clinical focus.

1. Nurse Practitioner (NP)

NPs are the most common type of APRN, trained to provide primary and specialty care. They often serve as frontline providers, managing chronic conditions, prescribing medication, and coordinating care.

2. Clinical Nurse Specialist (CNS)

CNSs are clinical experts who provide advanced care in specialized areas (e.g., cardiology, oncology, behavioral health). They frequently serve in hospital-based or team-oriented settings and help implement system-level improvements.

3. Certified Nurse Midwife (CNM)

CNMs focus on women's health and reproductive care, including prenatal visits, labor and delivery, and postnatal support. They are QHPs under CMS but typically operate outside of chronic care management contexts.

4. Certified Registered Nurse Anesthetist (CRNA)

CRNAs provide anesthesia and pain management services in surgical and acute care settings. They are the least likely APRN group to engage in care management programs but are still QHPs with full billing authority in their domain.

Each of these roles is licensed at the state level and must meet national certification requirements to practice as an APRN.

Frequently Asked Questions about ARPNs

1. What does APRN stand for in healthcare?

APRN stands for Advanced Practice Registered Nurse, a category of licensed clinicians with graduate-level education and advanced clinical training.

2. What are the four types of APRNs?

APRNs include Nurse Practitioners (NPs), Clinical Nurse Specialists (CNSs), Certified Nurse Midwives (CNMs), and Certified Registered Nurse Anesthetists (CRNAs).

3. Is an NP an APRN?

Yes. A Nurse Practitioner is a type of APRN, alongside CNSs, CNMs, and CRNAs. NPs are the most common type of APRN in primary and chronic care.

4. Can APRNs bill Medicare for Chronic Care Management?

Yes. APRNs are considered Qualified Health Professionals (QHPs) and can bill for CCM, PCM, TCM, and other Medicare time-based codes—provided they’re properly credentialed.

5. Are all APRNs allowed to supervise other staff?

Yes. When billing Medicare, APRNs may supervise clinical staff such as RNs, care coordinators, or MAs under general supervision guidelines.

6. What’s the difference between an APRN and an RN?

APRNs are licensed at a higher level, with the ability to diagnose, treat, prescribe, and bill independently. RNs provide supportive clinical care but cannot bill Medicare for most standalone services.

7. Do all APRNs participate in chronic care programs?

No. While NPs and CNSs commonly lead or support CCM/PCM workflows, CRNAs and CNMs are less involved unless practicing in integrated settings with high-risk populations.