Wiki Payment Reduction for APP Performing Procedure/Tests?

[toria11]

Is payment reduced to 85% when an APP performs procedures/tests and bills directly (not incident-to)? Also, how are we to know which procedures/tests can be billed incident-to? Thanks.

 

[CBLENNIE]

You might check out this CMS page regarding payment and fee schedules for Advanced Practice Nonphysician Practitioners. Also, you may find some helpful information in the IOM 100-04 Medicare Claims Processing Manual Chapter 12 Physicians/Nonphysician Practitioners section 110 for PAs, section 120 for NPs & CNS, section 130 for Nurse-Midwife Services.

There is also a page within the Advanced Practice Nonphysician Practitioners site Incident To Services & Supplies which outlines the guidelines of what meets the criteria for incident to billing but as for a list of specific services that can be performed as incident to, what is within the APPs scope of practice in their state is going to govern which procedures can be performed incident to.