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incident to question

  1. #1
    Default incident to question
    Medical Coding Books
    I am now working for a pain management clinic that has a massage therapist and a PA. My questions are:

    1. The doctor works on call for the hospital. He sometimes sends his PA to do the rounds & consults. (NP & Followups) Can this be done? I didn't think it could.

    2. The PA & the massage therapist see patients in the office when he is not there. My understanding is that the PA can bill using her NPI # in this case, only if they are current pts with no new problems. For the massage therapist, the doctor needs to be in the office in order to bill for the service. Am I correct?

    3. We are also starting Physical Therapy. Does the doctor need to be present for his services since he has all of his own numbers?

    Please advise, I can use all the help I can get.


  2. #2
    Default Incident to question
    The term "Incident to" pertains to Medicare only - Physician Assistants can bill independently (under their own provider number) for commercial carriers following the general supervision rules. This means that the physician does not have to be present in the office / clinic at the time the independent service is being performed but must be available by phone. Typically there is no reduction in fee for these services.

    Medicare will pay for independent services billed "incident to" performed by the PA providing it is not a new patient or consult, it is an established problem with an established treatment plan. If this criteria is not met than the PA must bill using their own provider number and is subject to 85% reimbursement.

    Non Physician Practitioners such as PA's cannot bill "incident to"for hospital services related to Medicare patients.

    Hope this helps,
    Maria A. Candia CPC

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