Key Components of “Incident To” Billing

Key Components of “Incident To” Billing

Incident-to billing is a way of billing outpatient services (rendered in a physician’s office located in a separate office or in an institution, or in a patient’s home) provided by a non-physician practitioner (NPP) such as a nurse practitioner (NP), physician assistant (PA), or other non-physician provider. 

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Dentist collaborating with IBCLC

*Physician must be onsite (some interpret this as being present during part of exam).
*The supervising physician need not be the physician who performed the initial service.
*Physician must be in-network with said insurance company.
Insurance company must accept incident to billing.
*Patient must have established care with physician. 
*The NPP must be employee or contractor of physician.                 If there is change of diagnosis, physician must step in to initiate new plan.
Dentists can bill using medical codes for certain procedures, including frenotomies.

All of the above requirements leave a lot of room for physician judgement in terms of how they institute policies.

Some references:

Medical Economics
Medicare Learning Network