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Regarding incident to, during the COVID-19 Public Health Emergency (PHE) the requirements were changed to include being available via audio and/or visual technology, and this was extended to the end of 2024. Is this still valid information for 2025?

Read more about Regarding incident to, during the COVID-19 Public Health Emergency (PHE) the requirements were changed to include being available via audio and/or visual technology, and this was extended to the end of 2024. Is this still valid information for 2025?

As explained by CMS in the calendar year (CY) 2025 final rule:

Under Medicare Part B, certain types of services, including services incident to physicians’ or practitioners’ professional services, are required to be furnished under specific minimum levels of supervision by a physician or practitioner. For most services furnished by auxiliary personnel incident to the services of the billing physician or practitioner, direct supervision is required.

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February 24, 2025

When billing Medicare for injections that are provided incident-to by a nurse practitioner (NP) or other non-physician practitioner (NPP), does the supervising physician have to sign off on the injection?

Read more about When billing Medicare for injections that are provided incident-to by a nurse practitioner (NP) or other non-physician practitioner (NPP), does the supervising physician have to sign off on the injection?

No. Although the injections are billed under the supervising physician’s NPI, he or she is not required to see the patient or document any notes in the patient’s medical record.

A service that is billed as incident-to is one that is furnished as an incidental but integral part of the physician’s professional services in the course of the diagnosis or treatment of the patient’s injury or illness.

Therefore, in order to bill for injections provided incident-to by an NP or NPP, the following criteria must be met:

Can services of a physical therapy assistant be billed incident-to a physician’s services?

Read more about Can services of a physical therapy assistant be billed incident-to a physician’s services?

No. The services provided by physical therapist assistants (PTAs) cannot be billed incident-to a physician/non-physician practitioner’s (NPP), because PTAs do not meet the qualifications of a therapist. Only the services of a licensed/registered physical therapist can be billed incident-to a physician service. PTAs may not provide evaluation services, make clinical judgments or decisions, or take responsibility for the service. PTAs act at the direction and under the supervision of the treating physical therapist and in accordance with state laws.

If a new patient comes into the office and sees our physician assistant (PA), can our PA bill this as incident-to the physician, who is also in the office seeing patients?

Read more about If a new patient comes into the office and sees our physician assistant (PA), can our PA bill this as incident-to the physician, who is also in the office seeing patients?

No. In order for the service to qualify as incident-to, an initial encounter must have occurred between the physician and the patient, and a course of treatment established by the physician. In this situation, services performed by the PA do not meet the incident-to requirement and would not qualify because this is a new patient. The claim would be billed listing the PA as the performing provider.