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August 5, 2013

"Incident to" Services: Where and by Whom?

The rules: The CMS Benefit Policy Manual (Pub.100-02), chapter 15, Covered Medical and Other Health Services, section 60 Services and Supplies 60.1, states:

Incident to a physician's professional services means that the services or supplies are furnished as an integral, although incidental, part of the physician's personal professional services in the course of diagnosis or treatment of an injury or illness.

Office Services: Auxiliary or ancillary employee or personnel

  • Incident to for auxiliary personnel (non-Medicare eligible) is limited to situations in which there is direct supervision by the physician (the billing physician).
  • This is different than the NPP who should have a Medicare PTAN but is working "incident to" and still has direct supervision by the billing physician. See below.
  • Auxiliary personnel or office personnel work incident to the billing physician under direct supervision for vital signs, venipuncture, EKGs, injections, but not post-op visits.

For Evaluation & Management (E/M) services, ancillary employees may provide documentation in the following three areas:

  • History
    • Review of systems (ROS),
    • Past/family and social history (PFSH)
  • Exam
    • Constitutional organ system (vital signs, and weight etc.)
  • All other work is physician/non-physician (NPP) provider work.

Non-Physician Practitioner "Incident to" policy requirements are:

  • Service (as always) is medically necessary
  • NPP is an employee of the physician or of the same employer
  • Patient is an established patient
  • Physician provides direct supervision
  • The service is the type of service commonly performed in a physician's office
  • The service is an integral, although incidental, part of the physician's professional service
  • The service is part of a course of treatment of which the physician personally performed the initial service
  • The physician is actively involved in the course of treatment


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