Can a nurse practitioner or other qualified health care professional (QHP) providing a follow-up evaluation and management (E/M) service incident to a pediatrician’s plan of care address a new problem or abnormal finding and still bill incident to the physician’s service (ie, as if the physician personally provided the service)?

No. A service to address a new problem or finding is not reported as incidental to a physician’s service and must be reported under the name and National Provider Identifier (NPI) of the performing provider (eg, nurse practitioner). The Medicare incident-to policy allows a physician to report services provided by QHPs only under specific circumstances.

Clinical staff may also provide certain services incident to a physician or other QHP’s service under this policy.

Be sure to verify the credentialing and payment policy of individual health plans when reporting services of other QHPs. Some health plans require that all services by...

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