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Medicare and “Incident-To” Rule

Medicare and “Incident-To” Rule


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Nancy Maguire, ACS, HCS-D, CRT
 
Medicare has a rule known as “incident-to.” This billing rule is an effective tool used as an extender for physicians. The incident-to rules were established to cover services that are “an integral, although incidental, part of the physician’s personal professional services to the patient.” In a nutshell, the physician must perform the initial service for the condition(s). Subsequent patient encounters, in the office setting, can then be performed by a nonphysician practitioner (NPP) or auxiliary personnel as if the physician performed the services himself or herself. So there must have been a direct, personal, professional service furnished by the physician to initiate the course of treatment of which the services being performed by the NPP, (e.g., Physician Assistants [PAs], nurses, Nurse Practitioners [NPs], medical technicians, medical assistants) are an incidental part.