Medicare “Incident To” Update and Reminders

Medicare “Incident To” Update and Reminders

By: Joy Newby, LPN, CPC | Newby Consulting, Inc.

WPS Reverses Decision on Allergy Injections and “Incident To” Billing

On January 18, 2016, WPS GHA published an article in eNews indicating

…if the physician employing the person giving an allergy injection is not the physician treating the allergy, “incident to” requirements are not met and the service should not be billed to Medicare…

The article explained that part of the requirement for “incident to” is that the billing physician (treating physician or a supervising physician/ qualified health care professional of the same group practice) is treating the patient for the illness or injury. Under this interpretation of the “incident to” requirements, the only way a PCP (primary care provider) could bill for administering an allergy injection based on the allergist’s plan of care is if the physician or practitioner personally administered the injection. Knowing that for various reasons many patients evaluated by an allergist who prepares the serum specific to the patient, choose to have their PCP administer the injections, we requested WPS review and revise their interpretation.

Read the full article here (PDF file)