Incident to

When NPP's provide incident to services, are they allowed to bill on time when it's been properly documented as more than 50% of the visit is spent counseling and/or coordination of care, ect.? The reason for the question is that an article from the AAFP stated, ...when billing incident-to, nonphysician providers cannot be reimbursed for consultaions or time-based E/M services..., "according to the Carrier's Manual, the only time that counts is face-to-face time between physician and the patient in the office." I've read the Medicare Incident To rules and didn't see anything about whether an NPP could or could not bill on time when providing incident to services. Please provide the Medicare document source. Thank you.

Incident to

As I read the manual, yes, NPPs can select an E/M code based on time. Some consultants say no, but I don't see the evidence of it.

incident-to

Medicare does imposes these restrictions on incident-to:
(1) consultations and (2) visits billed based on time spent on counseling or coordination of care cannot be billed “incident to”, in physician name.

Incident to

Thank you. I need to provide Medicare documentation (to show to my providers) to support the restrictions. Could you please tell me where you found the information. Thanks.

Incident To

The local carrier here is Noridian. I don't know if that information helps or not. If anyone can provide me with the pub., chapter, and section in the Medicare manual that specifically states that NPP's cannot bill when greater than 50% of the visit is spent in counseling and/or coordination of care when providing incident to services, I would would really appreciate it. Thank you very much.

incident to

I don't think you'll find it explicitly. The article in Codapedia cites the Medicare manual about incident to, but it won't say this directly. Ditto for using time to select a code.

When I've seen this debated, usually the "you can't bill the NPP based on time" proponent finds the parts of the manual about time, and maybe the word "physician" is in there explicitly (I can't remember now)

Maybe Nancy can point us to a specific section, but as I read Pub 100-04, Chapter 12, on either incident to or using time, I don't interpret it that way. sorry. You might call your carrier/MAC and ask.