Consistently and deliberately billing for services incident to the
physician's provider number may be critical to every practice offices.
How do we describe an "Incident to"?
- The health giver is receiving direct supervision from the medical physician on the
date of service
- The service is a part of the current treatment plan of which the medical physician
did the initial evaluation, plan of treatment and course of treatment. The
supervising physician is actively involved in the course of treatment.
Health Providers such as Physician Assistants, Nurse Practitioner,
Physical Therapists, Occupational Therapists & Speech Therapists are
example of health providers that might me providing services under the
group or a solo practitioner.
These providers are all under the direct supervision of the Medical
Doctor who did the initial evaluation, plan of care and course of
treatment. Services are rendered to patients as if the supervising MD
saw the patient himself.
If the Insurance Companies that your practice participates with
credentials for instance the PAs, upon issuance of his/her provider
number with the insurance company, your practice must start billing
that insurance company under his/her provider number rather than
using the supervising MDs provider number, under the group number or
tax ID number.
Though "incident to" services are being paid at 85% (MEDICARE) based
on the contracted rate/professional fee schedule of that for the
Learn more about "Incident to" (downloaded from CMS):
NEW/REVISED: Medicare Claims Processing Manual
Chapter 12 - Physicians/Nonphysician Practitioners (Rev. 2044, 09-03-
10) - see page 38
- Supervising MDs must be present on the same suite/floor with the supervised health
giver. Not necessarily on the same treatment room.
- Supervised health giver can NOT see a New Patient, New Case & New Problem.