What does incident to billing mean?

Defined. “Incident to” services are defined as services or supplies 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. Reimbursement. Reimbursement is based on 100% of the physician fee schedule amount.

Does incident to billing require a modifier?

Billing. Services rendered ‘incident to’ a physician’s service should be billed under the employing physician’s NPI , or in the case of a physician directed clinic the supervising physician’s , and are reimbursed as if the physician performed the service (no modifier required).

How does incident billing work?

“Incident to” billing permits nonphysician practitioners to bill certain services using the physician’s CMS-issued unique 10-digit identification number, known as a national provider identifier.

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What are the rules for incident to billing?

Additional rules apply for incident to billing of physician’s services in clinic, and services incident to a physician’s service to homebound patients under general physician supervision. These can be found in the Medicare Benefit Policy Manual, Chapter 15, Section 60. John Verhovshek, MA, CPC, is a contributing editor at AAPC.

Can a physician get a bonus for providing an incident to service?

Physicians in what Stark defines as a “group practice” may receive productivity bonuses both for services they personally perform (including designated health services) as well as for services provided incident-to those services. However, those bonus payments cannot be based directly on the volume or value of referrals.

What was the AAPA report on Medicare incident to billing?

The report included a recommendation to eliminate “incident to” billing for PAs (physician assistants) and advanced practice registered nurses (APRNs) under the Medicare program. AAPA posted a statement responding to this recommendation, which may raise questions in the PA community.