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Incident to

  1. Default Incident to
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    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
    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

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