E/M Coding Alert - 2003 Issue 9
INCIDENT-TO BILLING: Ask Your Local Carrier About Incident-To Requirements
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Article Overview
This article discusses incident-to billing for nonphysician practitioners and the practical factors that affect whether services can be billed under a physician’s supervision. It focuses on broad compliance considerations such as physician availability, state licensing and scope issues, and the role of local Medicare carriers and professional associations in clarifying requirements. The piece is relevant to physicians, nonphysician practitioners, billing staff, and compliance professionals.
Why This Topic Matters
Incident-to billing can affect how services are reported and paid, but the requirements vary by location and by practitioner type. Understanding the general compliance framework helps practices avoid billing under arrangements that do not meet applicable federal or state expectations.
What You Will Learn
- General incident-to billing concepts for nonphysician practitioners
- How physician supervision and location can affect incident-to billing
- Why state law and licensure matter in determining which services may be furnished
- How local Medicare carriers and professional associations can help clarify requirements
Who Should Read This
- Physicians
- Nonphysician practitioners
- Medical coders
- Billing staff
- Practice managers
- Compliance professionals
Codes Discussed
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