Yes, if ALL of the requirements for incident to billing are met. (The "substantive portion" of the visit language you referenced in the initial post comes from split shared facility visits, and is not part of incident to requirements.)
Incident To:
- Office setting
- Direct supervision of the physician (meaning a physician is in the office suite for the entire visit and immediately available for assistance/direction)
- Established patient with a plan of care initiated by the physician
- APP is following the physician's established plan of care (no new diagnoses during the visit - if a new secondary condition is evaluated by the APP during the visit, the services are no longer incident to the physician's treatment plan)
- Physician must actively participate and manage the patient's course of treatment (meaning that there must be subsequent physician services at a frequency that reflects the physician's continuing active management of the course of treatment)
Also the physician and the APP should both be employed or contracted by the practice and actively enrolled with Medicare (check with your commercial payers on their enrollment requirements)
You'll also want to be sure your documentation shows the link between the APP services and the physician services. I'm pasting below some documentation information from a recent presentation by Christine Hall on Incident To. (BTW - if you ever have the opportunity to hear Christine speak about Incident To, I highly recommend it. She breaks down the entire incident to benefit in a way that makes it easier to understand.)
Documentation requirements for patients seen under “incident to”:
- Identify who rendered the service
- Indicate supervision requirement is met
- Show physician’s initiation and continued involvement in treatment
- Reasonable and necessary
- Within scope of practice for the QHP
The documentation submitted to support billing “incident to” services must clearly link the services of the NPP auxiliary staff to the services of the supervision physician. Evidence of the link may include:
- Co-signature or legibly identify and credentials (i.e., MD, DO, NP, PA,etc.) of the both the practitioner who provided the service and thesupervising physician on documentation entries.
- Documentation from other dates of service, for example the initial visit establishing the link between the two providers.
- Make sure the name and professional designation of the person rendering the service is legible in the documentation of each service