Wiki Incident 2 billing

[risnerclan]

We have a PA who sees a new patient and determines the patient needs an injection so she performs the injection same day. BCBS does not allow for PA's to be reimbursed for injections and we are being told that because the plan of care was established we can bill the injection incident 2. Does anyone have any guidance on this, it seems pretty grey to me.

 

[SharonCollachi]

The care plan has to be developed by an MD, not the PA. There is no one to bill this incident-to, as the MD did not develop the plan of care.

 

[csperoni]

Agree with Sharon on this. One of the incident to requirements is that the NPP is following the physician plan of care. There are some carriers that do allow NPP services to be billed under the MD with other requirements. If they gave it to me in writing for a commercial payor, only then would I bill under the physician.