MLN: 'Incident To' Services in Medicare Part B
Reference to Medicare's incident-to billing rules permitting auxiliary personnel to furnish services billed under the physician's NPI, with strict supervision and treatment-plan requirements.
Primary source
MLN Booklet — 'Incident To' Services →https://www.cms.gov/outreach-and-education/medicare-learning-network-mln/mlnproducts/mln-publications-items/mln006764
Verified May 23, 2026 · This is the authoritative regulator URL. The summary below is a research aid; the linked source controls.
Additional sources
Medicare's "incident to" billing rules permit services and supplies furnished by auxiliary personnel to be billed under a physician's NPI at the physician fee schedule rate (rather than the lower rate that would apply to direct billing by the auxiliary). The substantive policy is in Medicare Benefit Policy Manual Chapter 15 §60.
Requirements (all must be met):
- Initial visit by the physician establishing the patient's diagnosis and treatment plan; the physician initiates the course of treatment for the condition.
- Subsequent encounters by auxiliary personnel are for a condition the physician has already diagnosed and for which a treatment plan exists; new problems require a new physician visit.
- Direct supervision by the physician: the physician must be physically present in the office suite and immediately available to provide assistance and direction throughout the time the auxiliary personnel is performing the service.
- Employment: the auxiliary personnel is employed by the physician or the physician's group.
- Setting: the service is furnished in the physician's office or the patient's home (incident-to does not apply in facility settings such as hospital outpatient).
Documentation in the EHR must reflect the supervising physician's presence and the linkage to the established treatment plan. Audit exposure is high — incident-to billing for new problems, or absent direct supervision, are recurring findings.
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Last reviewed May 23, 2026 · Citation verified May 23, 2026
Research aid, not legal advice. This summary is an administrative research aid prepared by D3rx. It does not certify compliance, provide legal advice, replace counsel, or guarantee an audit outcome. For authoritative regulatory text follow the primary source link at the top of this page. The practice remains responsible for reviewing, adopting, and maintaining its compliance program.