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Q:

Can an out patient mental health clinic do "incident to billing" in this scenario? We have a Psychiatrist that is credentialed with insurance companies. There are 2 LPEs,(Licensed Psychological Examiner), that work in the office with her. Some insurance companies will not credential LPEs, so in this case could we do "incident to billing?"

A:

To be covered (By Medicare or Medicaid), incident to services must be:
  1. an integral, although incidental, part of the physician's professional service,

  2. commonly rendered without charge or included in the physician's bill,

  3. of a type that are commonly furnished in physician's office or clinics, furnished under the physician's direct personal supervision.
See Publication 14. at the following web site: http://www.hcfa.gov/pubforms/progman.htm see Section 2050.

Based on your information, it appears as if incident to billing would be acceptable if the LPE's work is part of the physician's work. In addition to physician must be on site and available.

 

Russell B. Still (bio...)
Executive Vice President

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