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Incident to

  1. Question Incident to
    Medical Coding Books
    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

    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
    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, CPC-I, CPB, CENTC, CRHC, AAPC Fellow
    Director of Operations
    Ear, Nose and Throat Associates of South Florida, PA

    "Nothing is stronger than the heart of a volunteer"

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