What condition would prevent incident-to billing for a service?

Incident-to billing allows healthcare providers to bill for services provided by non-physician practitioners, such as nurse practitioners or physician assistants, under the supervising physician's NPI number, ensuring that the services are considered part of the overall treatment plan.

For incident-to billing to be applicable, the service must meet specific criteria, one of which is that the physician must be present in the same office or facility where the service is provided. If the physician is providing treatment at a different facility, they cannot directly oversee the service being rendered. This lack of immediate supervision would disqualify the service from being billed as incident-to, as it does not align with the necessary conditions set forth in the guidelines.

Therefore, it is crucial for incident-to services to occur within the practitioner's established practice, while the supervising physician is available at that same location. This regulation ensures that the service is integrated into the overall treatment and oversight provided by the physician.