Health Information Management

Tip: Qualifying for incident-to coverage

APCs Insider, June 13, 2014

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Hospital outpatient therapeutic services, such as ED or clinic visits, that are paid under the OPPS or to critical access hospitals (CAH) on a cost basis must be furnished "incident-to" a physician's service to be covered.
In order to qualify for "incident-to" coverage, the service must be:
  • Furnished on the order of a physician or nonphysician practitioner (NPP) in a hospital or provider-based department of the hospital
  • Furnished as an integral part of treating the patient
  • Provided under the appropriate level of supervision (e.g., general, direct, or personal)
This tip is adapted from “Hospital Outpatient Payment Panel makes recommendations to CMS” in the June issue of Briefings on APCs.

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