Incident to services and supplies are those provided as an integral, although incidental, part of the physician’s or nonphysician practitioner’s personal professional services during diagnosis and treatment. Physicians, Nurse Practitioners (NPs), Certified Nurse-Midwives (CNMs), Clinical Nurse Specialists (CNSs), and Physician Assistants (PAs) are nonphysician practitioners who are authorized to have services provided by auxiliary personnel.
NPs, CNMs, CNSs, and PAs may enroll in, and get payment from us, for “incident to” services and supplies provided by auxiliary personnel that they supervise. Additionally, NPs, CNMs, CNSs, and PAs only have the option of providing services as auxiliary personnel incident to the professional services of a supervising physician or nonphysician practitioner. States cover and pay 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 listed practitioner’s bill.
- Are an expense to the physician or other listed practitioner.
- Are commonly provided in the physician’s or other listed practitioner’s office or clinic.
- Physician or other listed practitioner provides direct supervision for the “incident to” services, and only the physician or other listed practitioner who supervises the incident to services may bill them.
- We 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.