Dermatology World Column Discusses Billing Medicare for 'Incident To' Services

A column in the latest issue of Dermatology World, the official magazine of the American Academy of Dermatology Association, focuses on billing Medicare for "incident to" services.

CMS defines "incident to" services as services furnished incident to physician professional services in the physician's office (whether located in a separate office suite or within an institution) or in a patient's home. These services are billed as Part B services to a carrier as if a physician personally provided them, and are paid under the physician fee schedule.

Note: "Incident to" services are also relevant to services supervised by certain non-physician practitioners such as physician assistants, nurse practitioners, clinical nurse specialists, nurse midwives or clinical psychologists. These services are subject to the same requirements as physician-supervised services. "Incident services" supervised by non-physician practitioners are reimbursed at 85 percent of the physician fee schedule.

To qualify as "incident to," services must be part of a physician's patient's normal course of treatment, during which a physician personally performed an initial service and remains actively involved in the course of treatment. The physician does not have to be physically present in the patient's treatment room while these services are provided, but the physician must provide direct supervision; that is, the physician must be present in the office suite to render assistance, if necessary. The patient record should document the essential requirements for "incident to" service.

The Dermatology World column is written by Alexander Miller, MD, a physician in private practice who represents AADA on the AMA-CPT Advisory Committee. In the piece, Dr. Miller discusses Medicare's requirements for "incident to" services, specifically for physicians supervising licensed non-physician practitioners such as PAs or NPs.

He also discusses five example scenarios of "incident to" services. To access the Dermatology World column on billing Medicare for "incident to" services, click here.

Dermatologist billing is complex and ever-changing. To help ensure accurate and timely reimbursement, more dermatologists are researching their options for outsourcing medical billing vendors and electing to partner with such a company as PGM Billing. To learn how PGM can manage all aspects of a dermatology practice's billing, contact PGM today.


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