CMS rescinds changes to incident-to billing rules

As reported yesterday by the Medical Group Management Association (

On May 30, the Centers for Medicare & Medicaid Services (CMS) announced its decision to rescind a recent transmittal on incident-to billing guidance. This action is a direct result of advocacy efforts led jointly by the Medical Group Management Association (MGMA) and the American Medical Association. This effort, supported by 30 other physician organizations, prompted CMS to consider the issue more thoroughly. In addition to rescinding the transmittal, the agency announced its intention to release a new transmittal at a future date.

Despite CMS' contention that Transmittal 87 served only to clarify the agency's incident-to billing rules, it would have, in fact, changed them significantly. The policy, originally released with little notice and education for providers, included:

  • Increased reliance on the discretion of Medicare contractors to determine whether a service by a nonphysician provider can be billed incident to a physician's care;
  • A narrow definition of "clinic," which appears to limit the provision of incident-to services in clinics other than those that are physician-owned and operated; and
  • Administratively burdensome documentation requirements, such as explicit documentation in patient medical records of credentials of clinical personnel performing incident-to services.

CMS intends to examine its incident-to billing guidance and has not ruled out changes to these rules. MGMA will continue to work with CMS and the physician community to ensure that any changes to incident-to billing rules make sense and that the agency will provide adequate notice and education before the new policy takes effect.

Read the physician community's letter to CMS.

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