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Incident To Services – Medicare

Medicare has specific rules for billing for nurse practitioners and physician assistants and other office staff incident to a physician services in an office.  This article explains them.

Definition of Incident-to services

Incident-to services are services provided in a physician office to Medicare patients that are incident-to a physician’s or non-physician practitioner’s (NPP) treatment and plan of care.  Use these in place of service 11. There are other non-facility settings in which incident to services may be provided, but office is the most typical.

Explanation

Incident-to care is care provided in the physician’s office or patient home incident-to the care provided by the physician. This means, that the patient must first be seen by the physician at a prior visit, the physician develops the plan of care, and that the care provided is an integral part of the physician’s treatment plan. The physician must stay actively involved in the plan of care and be in the office when the service is provided.

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Last revised December 28, 2020 - Betsy Nicoletti
Tags: medicare incident-to and shared services, primary care

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Our mission is to provide accurate, comprehensive, up-to-date coding information, allowing medical practices to increase revenue, decrease coding denials and reduce compliance risk. That's what coding knowledge can do.

In 1988, CodingIntel.com founder Betsy Nicoletti started a Medical Services Organization for a rural hospital, supporting physician practice. She has been a self-employed consultant since 1998. She estimates that in the last 20 years her audience members number over 28,400 at in person events and webinars. She has had 2,500 meetings with clinical providers and reviewed over 43,000 medical notes. She knows what questions need answers and developed this resource to answer those questions. For more about Betsy visit www.betsynicoletti.com.

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