Wiki Incident to billing scenario

[rsnow]

A nurse practitioner sees a Medicare patient for the initial visit and sets up a treatment plan, billing under them at 85%, because there was no supervising physician on-site. The patient returns for a second visit to see the nurse practitioner, but this time there is a supervising physician on site. Can that second visit be billed as incident to even though the patient has never seen the physician and the NP set up the initial treatment plan? Thanks.​

 

[CodingKing]

This does not meet the definition of incident to. Physician must evaluate patient and visit must be administered under the physicians plan of care.

https://www.cms.gov/Outreach-and-Ed...k-MLN/MLNMattersArticles/downloads/se0441.pdf

To qualify as “incident to,” services must be part of your patient’s normal course of treatment, during which a physician personally performed an initial service and remains actively involved in the course of treatment.