CMS Issues Clarification Regarding “Incident To” Services

From the Vinson Elkins law firm (

On May 2, 2008, in response to multiple inquiries, CMS issued a set of clarifying instructions regarding policies for services furnished incident to a physician or non-physician practitioner (NPP) service in the office setting. The clarifying instructions, issued in Change Request 5288, amend and add new material to Chapter 15 of the Medicare Benefit Policy Manual. Among the key points set forth in the clarification include:

  • When contractors are aware that a service is furnished by staff other than the supervising physician/NPP, contractors will not make payment for the service as “incident to” the physician/NPP service unless there is documentation in the medical record authorizing the service.
  • The medical record must also contain the name and professional identities of the persons who furnished the incident to services.
  • Contractors will apply the policies for incident to services furnished in the office setting only to services furnished in the identifiable boundary of an office or a single room.
  • When services are provided outside the office, e.g., in the home or in the SNF outside the boundaries of an office suite, the supervising physician or NPP must be in the same room as the patient and the staff furnishing the incident to service, providing the equivalent of personal supervision.

The full manual update can be found on the CMS website here. A provider education article can be found in the MLN Matters section of the CMS website here.

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