Page 85 - Medicare Benefit Policy Manual

This does not mean, however, that to be considered incident to, each occasion of service
by auxiliary personnel (or the furnishing of a supply) need also always be the occasion of
the actual rendition of a personal professional service by the physician. Such a service or
supply could be considered to be incident to when furnished during a course of treatment
where the physician performs an initial service and subsequent services of a frequency
which reflect his/her active participation in and management of the course of treatment.
(However, the direct supervision requirement must still be met with respect to every
nonphysician service.)

Direct supervision in the office setting does not mean that the physician must be present
in the same room with his or her aide. However, the physician must be present in the
office suite and immediately available to provide assistance and direction throughout the
time the aide is performing services.

If auxiliary personnel perform services outside the office setting, e.g., in a patient’s home
or in an institution (other than hospital or SNF), their services are covered incident to a
physician’s service only if there is direct supervision by the physician. For example, if a
nurse accompanied the physician on house calls and administered an injection, the
nurse’s services are covered. If the same nurse made the calls alone and administered the
injection, the services are not covered (even when billed by the physician) since the
physician is not providing direct supervision. Services provided by auxiliary personnel in
an institution (e.g., nursing, or convalescent home) present a special problem in
determining whether direct physician supervision exists. The availability of the physician
by telephone and the presence of the physician somewhere in the institution does not
constitute direct supervision. (See §70.3 of the Medicare National Coverage
Determinations Manual for instructions used if a physician maintains an office in an
institution.) For hospital patients and for SNF patients who are in a Medicare covered
stay, there is no Medicare Part B coverage of the services of physician-employed
auxiliary personnel as services incident to physicians’ services under §1861(s)(2)(A) of
the Act. Such services can be covered only under the hospital or SNF benefit and
payment for such services can be made to only the hospital or SNF by a A/B MAC (A).
(See §80 concerning physician supervision of technicians performing diagnostic x-ray
procedures in a physician’s office.)

60.2 - Services of Nonphysician Personnel Furnished Incident To

Physician’s Services
(Rev. 1, 10-01-03)
B3-2050.2

In addition to coverage being available for the services of such auxiliary personnel as
nurses, technicians, and therapists when furnished incident to the professional services of
a physician (as discussed in §60.1), a physician may also have the services of certain
nonphysician practitioners covered as services incident to a physician’s professional
services. These nonphysician practitioners, who are being licensed by the States under
various programs to assist or act in the place of the physician, include, for example,
certified nurse midwives, clinical psychologists, clinical social workers, physician