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Thread: Incident to billing (MD and PA-C)

  1. #1

    Default Incident to billing (MD and PA-C)

    AAPC: Back to School
    Can someone please clarify exactly what is expected of the Physician, when during office hours, a PA-C primarily treats the patient, but it is billed under the Physician's name/npi? Or direct me to where I can find this in writing? (We'll use Medicare as the insurer in this example) Thank You!

  2. #2


    You can get incident to rules on medicare's website. Also, if you do a search through previous posts, incident to rules have been covered on AAPC.

  3. #3


    I've printed and read different articles from CMS and Highmark on incident to billing; I just dont see anything that states exactly how much involvement the physician must have in order to bill the service under his name/npi rather than the Pa-c's info.
    I will search previous threads as you suggested. Thanks so much for your reply!

  4. #4
    Join Date
    Apr 2007
    Columbia, MO


    if you look in the Medicare manual section 2050 it will state that the physician must have already seen the patient for the exact same reason and there must be a plan of care then written by the physician to include any followup encounters and the physician you are billing under must be within the office suite are while the patient is being seen. Therefore it cannot be a new patient or new problem and be billed under the physician.

    Debra A. Mitchell, MSPH, CPC-H

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