The PPSA Definition of a Physician: Are PAs, NPs, and Dentists Now Included? (42 U.S.C. § 1320a-7h(e))

Open Payments' transparency hinges on who counts as the recipient of value. Under the Physician Payments Sunshine Act (PPSA), the statutory definition of “physician” at 42 U.S.C. § 1320a-7h(e) imports Social Security Act § 1861(r), which includes doctors of medicine or osteopathy, dentists, podiatrists, optometrists, and chiropractors (for covered chiropractic services). Dentists have been in scope as “physicians” from the start. Separately, CMS regulations expanded covered recipients to include physician assistants (PAs) and five advanced practice registered nurse (APRN) types for payments made on and after January 1, 2021. In the data, these new categories are reported as covered recipients, but they are not re-defined as “physicians.”

For small practices, the practical takeaway is simple: dentists fall under the statutory “physician” definition; PAs and APRNs are covered recipients by regulatory expansion. Accurate recipient typing, physician vs. non-physician covered recipient, prevents misreporting, reduces disputes, and protects your reputation in the Open Payments public file.

Patients, payers, and media increasingly consult Open Payments to understand financial relationships. Small practices often ask: Who exactly is in scope? The most common confusion arises around dentists, PAs, and NPs. The PPSA’s statutory “physician” definition explicitly includes dentists, but not PAs or NPs. Later rulemakings added PAs and five APRN categories to the covered recipient list without changing the statutory physician definition. This article clarifies those boundaries and gives clinics a lean playbook to classify, document, and, when necessary, dispute entries, without adding headcount or expensive software.

Legal Framework & Scope Under 42 U.S.C. § 1320a-7h(e)

Statutory anchor, who is a “physician.”
Section 1320a-7h(e) of Title 42 defines “physician” by reference to Social Security Act § 1861(r). That cross-reference encompasses:

• Doctor of medicine or osteopathy;

• Doctor of dental surgery or dental medicine (dentists);

• Doctor of podiatric medicine;

• Doctor of optometry;

• Doctor of chiropractic (only for legally authorized chiropractic services).

This means dentists are “physicians” for PPSA purposes, even when practicing in small office settings.

Regulatory expansion, who else is a “covered recipient.”
CMS regulations at 42 CFR § 403.902 define “covered recipient.” Originally limited to physicians and teaching hospitals, the rule now includes:

• Physician assistants (PAs);

• Nurse practitioners (NPs);

• Clinical nurse specialists (CNSs);

• Certified registered nurse anesthetists (CRNAs) and anesthesiologist assistants (AAs);

• Certified nurse midwives (CNMs).

These additions apply to payments made on or after January 1, 2021, which are included in calendar-year reports submitted the following year (42 CFR § 403.904).

What did not change.
The statutory definition of “physician” at § 1320a-7h(e) did not expand to include PAs or APRNs. Instead, the covered recipient universe expanded by rule to include them as their own categories. In practice and in the public data, “physician” and “PA/NP/etc.” appear as distinct recipient types.

Scope for clinics.

• Payments to dentists are physician payments.

• Payments to PAs/APRNs are non-physician covered recipient payments.

• Payments to teaching hospitals remain separately reportable.
  Knowing which bucket a clinician falls into drives how manufacturers tag the recipient and how your practice validates data in the CMS portal.

Wrap-up: Read § 1320a-7h(e) for the physician definition and 42 CFR § 403.902 for the full list of covered recipient types. Your documentation should make recipient typing effortless at audit time and during the CMS dispute window.

Program administration. CMS administers Open Payments: it receives manufacturer/GPO submissions, runs validations, publishes annual data, and manages the review and dispute process (42 CFR § 403.908).

Common triggers that implicate small practices:

• Mismatched recipient types (e.g., a PA posted as a “physician”), prompting a clinic-initiated dispute during the pre-publication window (42 CFR § 403.908).

• Identity resolution requests from manufacturers who need to confirm NPIs, credentials, and recipient type (physician vs. PA/APRN) prior to submission (42 CFR § 403.904).

• Media/payer inquiries after publication when a listing appears incongruent with state licensure or a provider directory.

Wrap-up: CMS owns the platform; manufacturers own the accuracy of their filings; practices own the narrative and the evidence to correct misclassification.

Below are lean controls mapped to the statute and regulations. Each item states how to implement, what evidence to retain, and a low-cost path to keep it running.

Control 1, Build a single “Recipient Type Roster” with NPIs and license types (42 CFR § 403.902; 42 U.S.C. § 1320a-7h(e)).

• Implement: Create a one-tab roster of all clinicians with columns for: name, NPI, state license number, license type, recipient type (Physician per § 1320a-7h(e) vs. PA/NP/CNS/CRNA-AA/CNM per § 403.902), and specialty taxonomy.

• Evidence: Copies of current licenses, DEA (if applicable), NPI confirmation pages, and CVs.

• Low-cost: A locked spreadsheet with drop-down validation for recipient type and a filter view for manufacturers upon request.

Control 2, Tag every transfer of value with the correct recipient type at intake (42 CFR § 403.904).

• Implement: When the practice receives a meal, grant, consulting fee, or educational item, log it and tag the recipient type immediately based on your roster.

• Evidence: Sponsor emails/invoices, agendas, and the internal log entry that shows the recipient type tag.

• Low-cost: A Google Form that staff complete in under a minute, feeding the master log.

Control 3, Embed recipient-type language in vendor agreements (42 CFR § 403.902, § 403.904).

• Implement: For engagements with mixed teams (e.g., a physician and a PA co-present), insert a clause requiring the administrator to capture recipient type as defined in PPSA rules and to map payments to each individual accordingly.

• Evidence: Executed contract or addendum; SOW explicitly listing participant roles and license types.

• Low-cost: One standard one-page addendum you attach to vendor templates.

Control 4, Pre-publication “credential sync” with manufacturers (42 CFR § 403.904; § 403.908).

• Implement: Sixty days before the CMS review window, email your roster (names, NPIs, recipient types) to frequent manufacturers, asking them to align their master data to your recipient types, especially for PAs/APRNs.

• Evidence: Email thread with the roster attached; a “version stamp” for the roster.

• Low-cost: A calendar reminder and mail-merge email from your compliance inbox.

Control 5, Dispute packets structured by recipient type (42 CFR § 403.908).

• Implement: When a listing is misclassified (e.g., your PA listed as “physician”), file a dispute with a three-page packet: (1) a cover letter citing § 403.902 definitions and § 1320a-7h(e); (2) your roster page for the individual; (3) a license/NPI printout.

• Evidence: Timestamped dispute submission, acknowledgments, and corrected listing confirmation.

• Low-cost: A reusable packet template and a folder of pre-saved license/NPI PDFs.

Control 6, Mixed-event meal handling (42 CFR § 403.904).

• Implement: For a single sponsored meal with both physicians (including dentists) and PAs/APRNs present, record attendees by recipient type. This allows manufacturers to segment the per-person allocations accurately across recipient categories.

• Evidence: Attendee roster with tags; sponsor receipt; event agenda stating the audience.

• Low-cost: A sign-in sheet template with a two-column tick box: “Physician (per § 1320a-7h(e))” vs. “PA/APRN (per § 403.902).”

Control 7, Media and payer talking points aligned to categorize (42 CFR § 403.902; § 403.904; § 403.908).

• Implement: Draft two 90-second scripts: (a) for physician listings (including dentists) and (b) for PA/APRN listings. Each script explains the nature of value, the independent educational/scientific purpose, and how the category is defined in federal rules.

• Evidence: Script files referenced to specific listings; an index linking listings to the roster and log.

• Low-cost: One-page PDFs stored with your evidence index.

Wrap-up: These controls sync your internal data model to the PPSA’s categories, making submission validation and dispute success straightforward for a lean team.

Case Study

Scenario: A four-provider primary care clinic includes one MD, one dentist, one PA, and one NP. A device manufacturer funds a lunch-and-learn, and the medical communications vendor later pays $1,000 honoraria to the MD and the NP for a follow-up Q&A session. When the clinic reviews draft Open Payments data, it sees two issues: (1) the dentist’s portion of the lunch was not captured at all; (2) the NP’s honorarium was posted under “physician.”

Analysis:

• Under 42 U.S.C. § 1320a-7h(e), the dentist is a “physician.” The meal should be attributed to the dentist as a physician recipient.

• Under 42 CFR § 403.902, the NP is a “covered recipient” but not a physician; the honorarium must appear under the NP category.

• Under 42 CFR § 403.904, the manufacturer is responsible for correct recipient categorization and identity resolution.

• Under 42 CFR § 403.908, the clinic can file disputes to correct both entries.

Action: The clinic submits two dispute packets:

1. For the dentist, the sign-in sheet tagging the dentist as “Physician (per § 1320a-7h(e)),” plus the vendor invoice.

2. For the NP, the roster page showing recipient type “NP (covered recipient per § 403.902), not physician,” plus NPI and license confirmation.

Outcome: The manufacturer updates the draft data, the dentist’s meal appears in the physician category, and the NP’s honorarium is re-coded under the NP category. The clinic adds a contract addendum for future events to require the vendor to collect recipient type at sign-in.

Consequences avoided: Public confusion about the NP’s status, avoidable media queries, and downstream payer questions during credentialing.

Wrap-up: This checklist keeps recipient types accurate at the source and equips your clinic to correct errors quickly during CMS’s dispute window.

Risk Traps & Fixes Under 42 U.S.C. § 1320a-7h(e) and 42 CFR § 403.902

Recipient-type errors are common and avoidable. These traps and fixes tie directly to federal categories and reduce disputes.

• Trap: Treating PAs/NPs as “physicians” in logs and invoices. Fix: Use the roster to tag PAs/APRNs as covered recipients under § 403.902, not physicians; verify that manufacturers mirror your tags. Consequence: Misclassification inflates physician totals and invites disputes (42 CFR § 403.904).

• Trap: Omitting dentists from the physician category. Fix: Remember, dentists are “physicians” under § 1320a-7h(e); ensure event rosters and per-person allocations reflect that. Consequence: Underreporting and confusion in public files.

• Trap: Ignoring mixed-audience meals. Fix: Collect sign-ins with recipient-type boxes; manufacturers need per-person splits across categories (42 CFR § 403.904). Consequence: Incorrect totals that are hard to unwind later.

• Trap: Vague contracts that skip recipient-type capture. Fix: Insert a clause obligating administrators to collect recipient type consistent with PPSA definitions (42 CFR § 403.902). Consequence: Recurring misclassification and more disputes.

• Trap: Late disputes without crisp citations. Fix: Build a three-page dispute packet template citing § 1320a-7h(e) and § 403.902, attaching roster and licenses (42 CFR § 403.908). Consequence: Prolonged errors in the public record.

• Trap: Uncontrolled identity data (NPIs/licensure) across inboxes. Fix: Centralize NPIs and license PDFs in your roster folder; circulate a pre-publication credential pack (42 CFR § 403.904). Consequence: Manufacturer mismatches and repeated identity queries.

Wrap-up: Tight controls on recipient typing, contracts, and credentials eliminate most preventable errors and keep the Open Payments narrative accurate.

Assign a single owner, the compliance lead, for the roster, evidence index, and dispute calendar. Designate a backup. Add two metrics to your quarterly dashboard: (1) percentage of transfers tagged with recipient type at intake; (2) percentage of events with signed rosters that include PPSA-consistent recipient-type boxes. Conduct an annual 30-minute refresher for all scheduling/front-desk staff focused on who is a physician under § 1320a-7h(e) and who is a covered recipient under § 403.902. Finally, verify every clinician’s Open Payments portal access before the review window opens to ensure timely dispute submissions (42 CFR § 403.908).

Under the PPSA, dentists are physicians by statute; PAs and APRNs are covered recipients by regulation. Knowing the difference is not academic, it controls how manufacturers report, how CMS displays results, and how stakeholders read your relationships. For a lean practice, a one-page roster and simple intake tags do most of the work. Contracts and dispute packets do the rest.

Immediate next steps for a small clinic:

1. Stand up a roster that tags each clinician by PPSA recipient type, with NPIs and license PDFs attached (42 U.S.C. § 1320a-7h(e); 42 CFR § 403.902).

2. Add a recipient-type checkbox line to every event sign-in and invoice confirmation (42 CFR § 403.904).

3. Update your standard vendor addendum to require PPSA-consistent recipient typing in all rosters and invoices (42 CFR § 403.902).

4. Schedule a credential sync with frequent manufacturers 60 days before the CMS review window (42 CFR § 403.904).

5. Prepare a three-page dispute packet template with citations and attachable roster/license artifacts for rapid corrections (42 CFR § 403.908).

• 42 U.S.C. § 1320a-7h – Transparency reports and reporting of physician ownership or investment interests

• 42 CFR § 403.902 – Definitions (Open Payments)

• 42 CFR § 403.904 – Reports of payments or other transfers of value

• 42 CFR § 403.908 – Procedures for review, dispute, and correction