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Thread: Incident To Billing

  1. #1

    Default Incident To Billing

    AAPC: Back to School
    Hello Everyone,

    I need to know what needs to appear on the claim for Medicare to indicate that an NPP provided services to a patient incident-to the physician's services.

    Does NPI of the NPP need to appear?
    Any specific modifier(s) needed?
    Anything else needed?

    Thank you!

  2. #2


    If it meets incident to requirements then you would bill under the physicians NPI number and would not use any modifier. Incident to only applies for E&M and the CMS requirements are: 1) The service must incur an expense to the billing provider (NPP must be an employee, leased employee or independent contractor) 2) Must be an integral part of the physician's professional service (physician must have initiated the course of treatment, incident to does not apply to new patients or established patients with a new problem) 3) 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 treamtent (meaning the dr cant see the patient once and you bill incident to for the next 20 office visits because the patient sees the NPP) 4) The physician must initiate the course of treatment first, (the physician must see patient first and come up with plan before billint incident to and 5) Must be furnished under direct personal supervision of the billing physician (dr does not have to see the patient, but must be in the same office suite and be immediately available.

    The above are CMS guidelines, different insurances have different guidelines depending on the carrier.

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