Page 83 - Medicare Benefit Policy Manual

may provide services without direct physician supervision and bill directly for these
services. When their services are provided as auxiliary personnel (see under direct
physician supervision, they may be covered as incident to services, in which case the
incident to requirements would apply.

For purposes of this section, physician means physician or other practitioner (physician,
physician assistant, nurse practitioner, clinical nurse specialist, nurse midwife, and
clinical psychologist) authorized by the Act to receive payment for services incident to
his or her own services.

To be covered incident to the services of a physician or other practitioner, services and
supplies must be:

• An integral, although incidental, part of the physician’s professional service (see
§60.1);

• Commonly rendered without charge or included in the physician’s bill (see
§60.1A);

• Of a type that are commonly furnished in physician’s offices or clinics (see
§60.1A);

• Furnished by the physician or by auxiliary personnel under the physician’s direct
supervision (see §60.1B).

B - Institutional Setting

Hospital services incident to physician’s or other practitioner’s services rendered to
outpatients (including drugs and biologicals which are not usually self-administered by
the patient), and partial hospitalization services incident to such services may also be
covered.

The hospital’s A/B MAC (A) makes payment for these services under Part B to a
hospital.

60.1 - Incident To Physician’s Professional Services
(Rev. 1, 10-01-03)
B3-2050.1

Incident to a physician’s professional services means that the services or supplies are
furnished as an integral, although incidental, part of the physician’s personal professional
services in the course of diagnosis or treatment of an injury or illness.

A - Commonly Furnished in Physicians’ Offices