Wisconsin lets APRNs practice without physicians, but Medicare billing may still require one

Wisconsin's advanced practice nurses no longer need a physician's name on a collaborative agreement to see patients on their own. Whether they can bill Medicare that way is still an open question.

The APRN Modernization Act, 2025 Wisconsin Act 17, took effect Sept. 1. On that date, the state converted every existing advanced practice nurse prescriber credential to an advanced practice registered nurse (APRN) license, according to the Wisconsin Department of Safety and Professional Services' implementation FAQ. For the first time, the law also creates a path for qualifying nurses to practice without collaborating with a physician or dentist.

The law covers four roles: nurse practitioners, certified nurse-midwives, clinical nurse specialists and certified registered nurse anesthetists.

Independence is not automatic

The license change happened overnight. The right to practice solo did not. Under emergency rules adopted by the Wisconsin Board of Nursing, an APRN must first log 3,840 hours of clinical practice as a registered nurse, then another 3,840 hours in an APRN role with a physician or dentist immediately available for consultation, according to an analysis by the Milwaukee law firm von Briesen & Roper. At least 24 months must pass for each stage. Applicants must also document those hours on a board-approved form, carry malpractice coverage, pay into the state's Injured Patients and Families Compensation Fund and pay a fee.

DSPS opened the independent practice application in early August. Only nurses who meet the requirements and receive board approval can drop their collaborative agreements, and that approval will appear on the license, the agency said.

The law also carves out limits. APRNs who use invasive techniques for pain management must still work with a pain medicine physician unless they practice in a hospital or hospital clinic or hold hospital privileges. Nurse-midwives who deliver outside a hospital must file an emergency transfer plan with the board.

The Medicare problem

State law is only half the picture for practices that employ APRNs. Federal rules for Medicare Part B cover nurse practitioner services only when they are performed in collaboration with a physician, the health law firm Hall Render noted in a June alert. The firm said it is not clear whether CMS will view Wisconsin's new law as satisfying that standard or treat it as the absence of a state collaboration law, and that commercial payers may have similar requirements.

Von Briesen reached a similar conclusion: an independent state license does not guarantee independent reimbursement. Certified nurse-midwives are the exception, since Medicare does not require them to have a collaborating agreement if they meet Wisconsin's requirements.

What practices should do now

Nothing in the law forces a practice to change its staffing model. Employers and medical staffs can still require APRNs to work under a collaborative agreement as a condition of employment or privileges, according to both firms.

Hall Render advised practices to review Medicare, Medicaid and commercial payer requirements before making staffing changes. It also suggested revising collaborative agreements rather than terminating them until CMS or the board offers more clarity. Other steps the firms recommend:

• Verify each APRN's hours and months of practice before ending any agreement.
• Confirm malpractice coverage and compensation fund participation.
• Update bylaws, privilege forms, job descriptions and employment contracts to reflect the new title and scope.

Practices that let an APRN go solo too early carry real risk. Von Briesen noted that the board has signaled an APRN who practices independently without its authorization may face discipline.

How Wisconsin got here

Gov. Tony Evers vetoed earlier versions of the bill in 2022 and 2024. The version he signed in August 2025 added the longer supervision requirement, the pain management limits and title protections that bar APRNs from using titles that could lead patients to mistake them for physicians. The Wisconsin Medical Society, which had opposed earlier bills, moved to neutral after those changes, the Wisconsin Examiner reported. Mark Grapentine, the society's policy advocate, told lawmakers the governor and legislators had "listened to the concerns that physician groups brought forward."

The board is operating under emergency rules for now, and permanent rules are still to come. APRN licenses will next renew in February 2028, according to DSPS.