Scroll Top

Incident To Billing Cheat Sheet

“incident-To” Billing Cheat Sheet

RULE OF THUMB: To qualify as incident-to, Services must be part of the patient’s normal course of treatment, during which a physician personally performed an initial service and remains actively involved during treatment. The physician does not have to be physically present in the patient’s treatment room while the services are provided, but they must provide direct supervision; meaning they must be present in the office for assistance if necessary. A physician must perform subsequent services that reflect his/her continued active participation in and management of the patient’s care

When to bill under np:

  • NP sees a patient for a new problem
  • If an established patient brings up a new problem during NP visit

Common incident-To Services:

  • Evaluation and management services (E/M)
  • Chemotherapy administration
  • Professional component of radiology services
  • Minor surgery
  • Office visits

services that do not apply:

  • Any services that can be provided without a physician’s supervision cannot be billed as incident-to; laboratory services (except those such as coagulation monitoring which requires visits for medication management), flu shots, EKG, certain radiology services, etc.
  • New patient office visits (CPT 99201-99205)
  • Preventive examinations and yearly physical exams including Medicare IPPE, AWV, etc (CPT 99381-99387, 99391-99397)
  • Any new problems encountered during the visit that are not addressed in the established plan of care. In this instance, the supervising physician needs to see the patient.
  • No services can be billed incident-to when the supervising physician is not present in the office

Resources & Credits:

“Any trademarks, logos, or links (sources) used throughout this blog are the property of their respective owners.”

Privacy & Cookie Information
When you visit our website, it may store information through your browser from specific services, usually in form of cookies. You will find our privacy and cookie policy below. By clicking "I Agree", you confirm you consent to our policies and/or have read them fully.

You can change your cookie setting's anytime. Please refer to your browser's help page to confirm how to disable cookies. Please note that blocking some types of cookies may impact your experience on our website and the services we offer.