"Incident to" does not apply in the hospital setting.
In the hospital setting, the consulting physician or qualified NPP shall use the appropriate Initial Inpatient Consultation codes (99251 – 99255) for the initial consultation service.
In the office or other outpatient setting, the consulting physician or qualified NPP shall use the appropriate Office or Other Outpatient Consultation (new or established patient) codes (99241 – 99245) for the initial consultation service.
When a qualified nonphysician practitioner (NPP) and a physician each provide a portion of the consultation services, the split/shared services may not be billed as a consultation, according to the Medicare Claims Processing Manual. If an NPP provides the bulk of the service, the NPP should report the appropriate code under his or her own provider number even if the physician documents examining the patient and reviewing the management plan.
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