Results 1 to 2 of 2

Incident to

  1. Default Incident to
    New Call-to-action
    I have an established patient that is seeing a physician's assistant under the supervision of a physician. The diagnosis is elevated PSA and it is a worsening condition. The PA orders a MRI or the prostate. When a PA orders this MRI, would this claim now have to be billed under the PA or would this be ok to still be billed under the physician?

  2. #2
    Default
    Incident to rules allow PAs and NPs to bill under a supervising physcian's NPI.
    One of the rules of Incident to is:
    • Billing 'incident to' the physician, the physician must initiate treatment and see the patient at a frequency that reflects his/her active involvement in the patient's case. This includes both new patients and established patients being seen for new problems. The claims are then billed under the physician's NPI.

    Looks like the patient is established and the problem is not new (worsening), so based on the information you have provided I would say you could bill under the Incident to rules and under the physican's NPI.

    However, some payers have different rules when it comes to Incident to, I would still double check the patient's insurance Incident to policy, just to be safe.

    Noridian (local MAC) Incident to
    "When you have exhausted all possibilities, remember this: You haven't!"
    -Thomas Edison

Similar Threads

  1. Incident to when there are two problems, one incident to and one new
    By CatchTheWind in forum Compliance General Discussion
    Replies: 2
    Last Post: 07-13-2017, 09:36 AM
  2. Incident to for a PA
    By lharding512 in forum Medicare Regulations
    Replies: 5
    Last Post: 04-28-2015, 02:31 PM
  3. Incident to
    By aformato1 in forum Billing/Reimbursement
    Replies: 4
    Last Post: 04-07-2015, 06:38 PM
  4. Incident to
    By jvalntine in forum Medical Coding General Discussion
    Replies: 0
    Last Post: 10-26-2010, 04:46 PM

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts
  •  
Enjoying Our Forums?

AAPC forums are a benefit of membership. Joining AAPC grants you unlimited access, allowing you to post questions and participate with our community of over 150,000 professionals.

Join Now Continue Reading Without Full Access

Already a Member?

Login

Close Message

In addition to full participation on AAPC forums, as a member you will be able to:

  • Access to the largest healthcare job database in the world.
  • Join over 150,000 members of the healthcare network in the world.
  • Be a part of an industry leading organization that drives the business side of healthcare.
  • Save anywhere from 10%-50% with exclusive member discounts on courses, books, study materials, and conferences.
  • Access to discounts at hundreds of restaurants, travel destinations, retail stores, and service providers. AAPC members also have opportunities to save on heath, life, and liability insurance.
  • Become a member of a local chapter and attend regular meetings.