05/13/2024

ASCO Coding Tip of the Month: May 2024

Incident-to services are provided by personnel including but not limited to physician assistants and nurse practitioners in non-institutional settings.  Inpatient services are subject to split or shared billing depending on payer policy.

Incident-to Rules:

• Services must be integral to physician’s professional services.
• Services must be of a type commonly furnished in an office or clinic.
• APP must be employed by the physician or practice either directly, contracted, or in a leased capacity.
• Direct supervision required.
• Established patients and conditions only; physicians must establish the care, diagnosis, and course of treatment for any condition to which the APP’s services follow.

The services would be reported under the supervising practitioner’s NPI, and payment would be based on the full physician PFS rate.  If conditions are not met, services would be billed under the APP’s NPI and subject to a reduced rate.  Not all payers allow incident-to billing. Please refer to individual payer policy for coverage.