Psychiatry Coding & Reimbursement Alert
Apply Incident-to Rules for NPP Services in Nursing Homes
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Question: I am interested in learning the proper rules for coding incident to services in a psychiatric practice. I have a nurse practitioner who is my employee and sees patients on my behalf in nursing homes. I practice in New York State.
New York Subscriber
Answer: To learn the proper rules for reporting services "incident-to" under Medicare, regardless of specialty, you are encouraged to read section 60 of chapter 15 of the Medicare Benefit Policy Manual on the CMS website.
While it is possible for a nurse practitioner's services to be covered "incident-to" in a nursing facility setting, all of the "incident-to" requirements in section 60 must be met, including direct supervision by the physician. Direct supervision in an institutional setting such as a nursing home is particularly challenging, so a careful read of section 60 as compared to your circumstance would be in order.
If the NP's services do not meet "incident-to" requirements, you still have the option to bill them directly to Medicare under the NP's own provider number.
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