Wiki Do other payers allow incident-to billing?

[maryek28@outlook.com]

Is Medicare the only payer that allows incident-to billing? I can't seem to get a straight answer from anywhere I've looked. We have medical assistants who perform injections and blood draws but I don't know if we can bill those services as incident-to to all payers or just Medicare.

 

[CBLENNIE]

Are you truly billing Medical Assistant (MA) services to Medicare under the "Incident To Services & Supplies" provision of the physician fee schedule? According to the Medicare only Advanced Practice Nonphysician Practitioners (APNP) are able to bill as incident to a physician and must enroll with Medicare in order to do so. They specifically list the following practitioners as eligible to bill as incident to:

• Advanced Practice Registered Nurses (APRNs)
  • Certified Registered Nurse Anesthetists (CRNAs)
  • Nurse Practitioners (NPs)
  • Clinical Nurse Specialists (CNSs)
  • Certified Nurse-Midwives (CNMs)
• Physician Assistants (PAs)

As for your question about whether other payers allow incident to billing, each payer has their own rules, although many follow the Medicare guidelines. I have worked in the commercial health insurance industry for 20+ years and I've never worked for a payer who would credential and enroll a MA and reimburse them for services. The service of an MA is considered part of the clinic staff and are under the direction of the physician or nonphysician practitioner and as long as the services performed are within the scope of their license of the state where they are working, their services would be bill under the physician or nonphysician practitioner along with the services performed directly by the provider.

 

[maryek28@outlook.com]

Are you truly billing Medical Assistant (MA) services to Medicare under the "Incident To Services & Supplies" provision of the physician fee schedule? According to the Medicare only Advanced Practice Nonphysician Practitioners (APNP) are able to bill as incident to a physician and must enroll with Medicare in order to do so. They specifically list the following practitioners as eligible to bill as incident to:

• Advanced Practice Registered Nurses (APRNs)
  • Certified Registered Nurse Anesthetists (CRNAs)
  • Nurse Practitioners (NPs)
  • Clinical Nurse Specialists (CNSs)
  • Certified Nurse-Midwives (CNMs)
• Physician Assistants (PAs)

As for your question about whether other payers allow incident to billing, each payer has their own rules, although many follow the Medicare guidelines. I have worked in the commercial health insurance industry for 20+ years and I've never worked for a payer who would credential and enroll a MA and reimburse them for services. The service of an MA is considered part of the clinic staff and are under the direction of the physician or nonphysician practitioner and as long as the services performed are within the scope of their license of the state where they are working, their services would be bill under the physician or nonphysician practitioner along with the services performed directly by the provider.

We have the MA do injections or blood draws and we bill it under the supervising provider's NPI. Is that not what incident to billing is? I've never been very clear on what is actually means.