Incident To Services & Supplies

Incident to services are Medicare-covered services and supplies that auxiliary personnel provide to a patient as an integral, although incidental, part of physician or non-physician practitioner (NPP) professional services. 

NPPs, such as nurse practitioners, certified nurse-midwives, clinical nurse specialists, and physician assistants, may bill and get payment from us for “incident to” services and supplies provided by auxiliary personnel they supervise. Auxiliary personnel may be nurses, technicians, therapists, or other employees. Medicare reimburses incident to services supervised by NPPs at 85% of what a physician gets under the Medicare Physician Fee Schedule (PFS).

Additionally, NPPs, Marriage and Family Therapists, and Mental health counselors have the option of only providing services as auxiliary personnel incident to the professional services of a supervising physician or NPP. The supervising physician or NPP bills for the services and we reimburse at 100% of the PFS. We pay for the services of an NPP under the incident to provision when services and supplies comply with applicable state law and meet all these requirements:

• Are an integral part of the patient’s normal treatment when the physician or other listed practitioner personally performed an initial service and remains actively involved in the course of treatment.
• Are commonly provided without charge or included in the physician’s or other NPP’s bill.
• Are an expense to the physician or other NPP.
• Are commonly provided in the physician’s or other listed practitioner’s office or clinic.

• Are provided under direct supervision by a physician or other listed practitioner for the incident to services, and only the physician or other listed practitioner who supervises the incident to services may bill them.

• Require general supervision by a physician or other listed practitioner when clinical staff have services and supplies provided incident to Transitional Care Management (PDF) and Chronic Care Management (PDF). Only the supervising physician or other listed practitioner may bill services and supplies incident to TCM and CCM services. Additionally, we require general supervision by a physician or other listed practitioner for behavioral health services provided by auxiliary personnel incident to the professional services of a physician or other listed practitioner.