Analysis of dermatologic procedures billed independently by nonphysician practitioners in the United States Journal Article


Authors: Qi, Q.; Hibler, B. P.; Coldiron, B.; Rossi, A. M.
Article Title: Analysis of dermatologic procedures billed independently by nonphysician practitioners in the United States
Abstract: Background: Nonphysician practitioners (NPPS), including nurse practitioners (NPs) and physician assistants (PAs) are expanding their scope of practice outside of primary care and performing more procedures in dermatology. Objective: To understand the scope and geographic pattern of practice by NPs and PAs in dermatology in the United States. Methods: Cross-sectional retrospective cohort analysis of dermatology practices in the 2014 Medicare Physician/Supplier Procedure Summary master file, which reflects Part B carrier and durable medical equipment fee-for-service claims in the United States. Results: Over 4 million procedures were billed independently by NPs and PAs, which accounted for 11.51% of all procedures. Injection, simple repair, and biopsy were the most commonly billed by the nonphysician practitioners, but complex procedures were also increasingly billed independently by NPs and PAs. Proportions of their claims are higher on the East Coast, Midwest, and Mountain states. Limitations: Data were collected at the state level and limited to Medicare beneficiaries, and did not include billing incident to physicians. Conclusions: This study demonstrated the increasing scope of practice of NPs and PAs in dermatology; this increase is alarming because of their limited training and the lack of uniform regulations guiding their practices. To ensure quality and safety of care, it is prudent to set benchmarks for proper supervision and utilization of procedures in dermatology. © 2018 American Academy of Dermatology, Inc.
Keywords: aged; retrospective studies; united states; cohort analysis; retrospective study; biopsy; medicare; physicians; physician; cross-sectional study; cross-sectional studies; dermatology; medical fee; fee-for-service plans; nurse practitioner; nurse practitioners; physician assistant; hospital billing; physician assistants; dermatological procedure; humans; human; article; current procedural terminology; scope of practice; dermatology practice pattern; nonphysician practitioner
Journal Title: Journal of the American Academy of Dermatology
Volume: 88
Issue: 5
ISSN: 0190-9622
Publisher: Mosby Elsevier  
Date Published: 2023-05-01
Start Page: e203
End Page: e209
Language: English
DOI: 10.1016/j.jaad.2018.08.047
PUBMED: 30227192
PROVIDER: scopus
PMCID: PMC10599153
DOI/URL:
Notes: Article -- Export Date: 1 May 2023 -- Source: Scopus
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  1. Anthony Rossi
    233 Rossi
  2. Brian Phillip Hibler
    55 Hibler
  3. Qiaochu Qi
    3 Qi