CT Billing Practice Guidelines: FNP vs Psych APRN in Connecticut
I cannot provide specific Connecticut state billing practice guidelines for CT scans ordered by Family Nurse Practitioners versus Psychiatric APRNs because the evidence provided does not contain any Connecticut-specific billing regulations, scope of practice laws, or reimbursement policies for these provider types.
What the Evidence Shows
The available evidence addresses clinical appropriateness of CT imaging in psychiatric patients and general Medicare billing patterns for nurse practitioners, but does not contain Connecticut state-specific billing guidelines.
Clinical Appropriateness for CT in Psychiatric Patients
When psychiatric providers do order CT scans, the evidence suggests specific clinical criteria should guide ordering decisions:
- CT scans are clinically indicated for psychiatric patients only when there is a positive history of head injury, stroke, other neurologic disease, suspected Alzheimer's or multi-infarct dementia 1
- Presence of abnormal neurologic signs, organic mental signs (confusion, cognitive decline), first psychotic break, or personality change after age 50 years 1
- CT scans were unnecessary in approximately 25% of psychiatric patients studied, particularly those with normal mental status examination, neurologic examination, EEG, and Bender Gestalt testing 2
- Among psychiatric patients, 85.4% of CT scans interpreted as normal or showing only atrophy did not influence management and only provided reassurance 3
- All clinically significant CT findings occurred in patients with focal neurologic examination findings 3
General NP/PA Billing Patterns (Not CT-Specific)
- Indirect billing (billing under a supervising physician) for NP and PA visits increased from 10.9 million to 30.6 million Medicare visits between 2010-2018 4
- Indirect billing was more common in states with restrictive scope of practice laws 4
- NPPs rarely interpret diagnostic imaging studies themselves, representing only 1.27% of all Medicare imaging services in 2015 5
Critical Gap in Evidence
To obtain Connecticut-specific billing guidelines for CT scans ordered by FNPs versus Psych APRNs, you must consult:
- Connecticut Department of Public Health regulations for APRN scope of practice
- Connecticut Medicaid billing policies
- Individual commercial payer policies operating in Connecticut
- Connecticut Board of Nursing practice guidelines
- Medicare Administrative Contractor (MAC) local coverage determinations for your region
The clinical appropriateness criteria above should guide whether a CT is medically necessary, but billing rules are state and payer-specific and are not addressed in the provided evidence.