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Thread: Incident to

  1. #1

    Question Incident to

    AAPC: Back to School
    I am very familar with incident to billing for CMS. I am wondering what guidelines other clinics/roviders are using for other insurance carriers. I cannot find anything in writing for other insurance carriers. I realize that "incident to" is actually a Medicare term but the situation applies to other insurances.

    I have a situation where a genetic counselor want to bill "incident to". She was told by her supervisor that the only requirement is a doctor signing off to bill under the doctor. She want to bill consultations codes for her services. The issue is the "signing" doctor is often the same as the "requesting" doctor. That is what they want my help on how to bill these as consults. Just does not seem right. Of course I need to prove whatever I advise in writing.

    thank you for any help or links!!


  2. #2
    Join Date
    Apr 2007



    Your best betis to talk with the different insurance companies. Our local blue cross will pay our pa the same rate as the dr. We also just signed a contract with a new plan for our Medicaid program that reimburses us 100% for our PA and 105% for our physician we dont need to bill incident to.
    Herbie W Lorona Jr., CPC, CPC-H

  3. #3
    Join Date
    Apr 2007
    Stuart Sailfish Chapter


    Julie. Its about the same for us. BCBS here in florida has the NP's guidelines on there website as they do not credential Nurse Practitioners or PA's. we bill under the supervising MD. as per there collaborative aggreement and NP protocals Both of our MD's ar supervising. we use a Variable code in our Practice Management system to determine what patients He sees for tracking purposes. Hope this helps.
    Candice Fenildo, CPC, CPMA, CPB, CENTC, CPC-I
    AAPC Chapter Association Board of Directors ( Chair)
    Region 6, Wisconsin, Minnesota, Illinois, Indiana, Michigan, Ohio

    "Nothing is stronger than the heart of a volunteer"

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