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Thread: Billing for a PharmD in physician office

  1. #1
    Join Date
    Apr 2007
    Sioux Falls South Dakota

    Default Billing for a PharmD in physician office

    AAPC: Back to School
    I was asked a question today that has me stumped. Our specialty clinics want to hire a PharmD who would help manage patients with multiple medications. The first clinic would be Medical Oncology, and the second that is thinking about it is Endocrinology. I have heard of a PharmD being part of the team in the inpatient setting, and even part of a case management team. However, they (the clinics) want to be able to bill out E/M for visits with the PharmD. I don't think that is possible; I have searched and don't find that they would qualify for "incident to" - and although they can get NPI numbers, I don't see where Medicare credentials them under Part B to provider Part B services. I would think other insurance companies would be the same. Our credentialing specialist is looking into that part.

    Does anyone have any experience with billing out services for a PharmD? Any help would be appreciated.

    Lucinda (Cindy) McGarry, CPC-P
    Applications Specialist
    Avera Health Plans
    Education Office Sioux Falls SD Local Chapter
    Past President Sioux Falls SD Local Chapter

  2. #2
    Join Date
    Apr 2007
    Tucson Cactus Coders


    Just wondering if you have any success in researching the incident to billing for Pharm D. visits?
    Deborah Herreraherreradeb1@gmail.com

  3. #3

    Default PharmD

    This same thing just happened in our office and I was wondering what the outcome was.

    I do not think that they should be billing incident to either but our physicians say they can.

    Any clarification would be greatly appreciated.

    thank you

  4. #4
    Join Date
    Apr 2007
    Jonesboro Chapter


    I am not sure if this helps. We are a teaching facility/clinic and we have 2 PharmD's on our staff. They do work with the med rec of the patient medication with the staff (both residents and faculty). However, we DO NOT bill for them. I don't think they are recognized by Mcare as a "qualified provider" in reference to billing incident-to.

    Hope this helps

    Tammy Frazier, CPC, CPCO, CPMA, CEMC

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