Keep in mind too that a new problem can never be billed as 'incident to' - the physician must always have a face-to-face service with the patient and personally initiate the plan of care for any new problem. 'Incident to' billing can only occur when the PA is executing an existing plan of care. So if the PA is just showing the patient a picture of a new problem, then that alone does not satisfy the 'incident to' requirements - the physician needs to document their own note. If that hasn't taken place, then the PA needs to bill this encounter under their own credentials.
Medicare has relaxed the supervision requirements during the pandemic, so direct supervision does not necessarily require the physician be on site, but the other requirements of 'incident to' billing are still in place.