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Thread: incident to

  1. #1
    Join Date
    Apr 2007

    Default incident to

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    When billing incident to, is there a time limitation for the treatment plan laid out by the collaborative physician in order to bill incident to? Fpr instance...if the patient was seen by the physician and told to follow up on their HTN in 6 months is there any problem billing this incident to? If the time frame is 1 year and the patient has been seen during that time for other problems but is following up on HTN a year later, can it still be billed incident to?

  2. #2
    Join Date
    Apr 2007
    North Carolina


    I can't say that I have ever seen a definitive time frame printed by CMS. This could become a regional issue. The physician establishes the course of treatment for a medical condition/illness for each new patient and each new problem,thereafter. The PA/NPP may bill "incident-to" for those services that have an established plan of care. Again...I'm sure there are states that have a restrictive policy on the frequency that the physician must stay involved in the patients care. My carrier does not...----->

    New patient-physician establishes plan of care
    New problem-physician establishes plan of care
    Established patient w/established plan of care-incident to is applicable

    My recommendation...check with your state to be certain.

  3. #3
    Join Date
    Apr 2007


    This is an area that is not well defined but I would err on the side of caution and say in your situation that is no longer incident to. The below is from CMS.

    "However, in order to have that same service covered as incident to the services of a physician, it must be performed under the direct supervision of the physician as an integral part of the physician’s personal in-office service. As explained in §60.1, this does not mean that each occasion of an incidental service performed by a nonphysician practitioner must always be the occasion of a service actually rendered by the physician. It does mean that there must have been a direct, personal, professional service furnished by the physician to initiate the course of treatment of which the service being performed by the nonphysician practitioner is an incidental part, and there must be subsequent services by the physician of a frequency that reflects the physician’s continuing active participation in and management of the course of treatment. In addition, the physician must be physically present in the same office suite and be immediately available to render assistance if that becomes necessary."

    Laura, CPC

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