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“Incident to” Job Aid for Place of Service Office

  1. Employed by the same entity - The person supervising and person performing the service must be employed by the same entity. They may be an employee, leased employee, or independent contractor.
  2. Only performed in place of service office - “Incident to” service can only be performed in the office setting to qualify for Part B Medicare billing purposes. You will enter POS 11 on the CMS-1500 form in item 24B or the electronic equivalent. Clinic means a physician owned and operated clinic and is not a hospital or other facility based clinic. It is an office but sometimes referred to as a clinic when multiple physicians of different specialties work together in a large office.
  3. The service must be integral although incidental. - That means the physician must perform the initial service to establish the diagnosis and plan of treatment, which means the patient, must be an established patient with an established diagnosis. To help clarify … the follow-up services rendered must be connected to the course of treatment the physician planned at the initial service. One of the keys to understanding incident to…is understanding services related to a previous service and tied to that previous service. Incident to billing does not apply to a NEW PATIENT or a NEW PROBLEM for an established patient.
  4. Active Participation - It is expected that the physician performs subsequent services of a frequency that reflect that active participation of the course of treatment for the specific problem. For example, a patient with chronic sinusitis will probably not have to be seen by the physician as often as a patient with congestive heart failure
  5. Direct Supervision - Incident to requires Direct Supervision. Direct supervision means the physician must be present in the office suite and immediately available and able to provide assistance and direction throughout the time the service is performed. The supervising physician does not have to be in the same room but must be in the office or clinic.
  6. Documentation - Documentation must also support evidence that the supervisor was present and available. The documentation submitted to support billing “incident to” services must clearly link the services of the NPP auxiliary staff to the services of the supervision physician. Evidence of the link may include:
    • Co-signature or legibly identify and credentials (i.e., MD, DO, NP, PA, etc.) of the both the practitioner who provided the service and the supervising physician on documentation entries.
    • Documentation from other dates of service, for example the initial visit establishing the link between the two providers.

    Make sure the name and professional designation of the person rendering the service is legible in the documentation of each service.

Incident to Job Aid for Place of Service Office
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