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Ancillary Services

  1. #1
    Default Ancillary Services
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    Currently our facilities bill ancillary services, ie, lab draws, injections, etc., under one provider at each facility (we have 3), even if the provider is not in the office. I don't believe this is correct. I have always been under the impression that the "rendering provider" must be in the clinic for his/her name to be on the claim. Am I correct? Do these services fall under the "incident to" rule? Can anyone direct me to the Medicare guideline that has instruction on this, please? And if these services do fall under the "incident-to" rule, does that mean the "rendering provider" has to sign off on the MA/RN/LPN note?

    Thank you for your help.

    Stefanie Cramer, CPC
    Independent Contractor
    Medical Coding and Consulting
    Cramer Consulting

  2. #2
    North Carolina
    In order for services of a nonphysician practitioner to be covered as incident to the services of a physician, the services must meet all of the requirements for coverage specified in ยงยง60 through 60.1. For example, the services must be an integral, although incidental, part of the physician's personal professional services, and they must be performed under the physician's direct supervision.

    Direct supervision in the office setting does not mean that the physician must be present in the same room with his or her aide. However, the physician must be present in the office suite and immediately available to provide assistance and direction throughout the time the aide is performing services.

    Start with section 60. There is other information throughout this chapter regarding "incident-to" requirements
    Rebecca CPC, CPMA, CEMC

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