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Last Modified: 10/2/2020 Location: FL, PR, USVI Business: Part B

Hospital visits and incident to provisions FAQ

Q: Can hospital visits provided by a nurse practitioner be billed as incident to his/her supervising doctor, as long as the doctor is also in the facility seeing patients?
A: The “incident to” provisions do not apply to hospital settings.
The only exception to this is when the physician establishes an office within a nursing home or other institution. Where a physician establishes an office within a nursing home or other institution, coverage of services and supplies furnished in the office must be determined in accordance with the “incident to a physician’s professional service” provision as in any physician’s office. A physician’s office within an institution must be confined to a separately identified part of the facility which is used solely as the physician’s office and cannot be construed to extend throughout the entire institution. Thus, services performed outside the office area would be subject to the coverage rules applicable to services furnished outside the office setting.
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