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:

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.

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.

The incident-to provisions do not apply to hospital settings.

Refer to section 8 of the SPOT User Guide.

Refer to section 6 of the SPOT User Guide.

Refer to: Restricted codes for claim reopenings

There are two tabs under eligibility that will provide helpful information regarding other insurance. 

The Medicare Advantage plan tab will provide you with the name, address, and other information for a patient’s Medicare Advantage plan, if applicable. The MSP (Medicare secondary payer) tab will provide the reason that Medicare is secondary, as well as the other insurance effective date and term dates, name, policy number and address.