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Incident to for Mental Health Provision

Outpatient psychiatric services furnished as 'incident to' professional services are limited to the following:

  • Physician
  • Clinical Psychologist
  • Nurse Practitioner 
  • Clinical Nurse Specialist
  • Physician Assistant
  • Certified Nurse-Midwife

To be covered and paid under 'incident to' the services and supplies must be furnished in compliance with State law and certain criteria must be met:

  • An integral, although incidental, part of the physician’s professional service 
  • Commonly rendered without charge or included in the physician’s bill 
  • Of a type that are commonly furnished in physician’s offices or clinics 
  • Furnished by the physician or by auxiliary personnel under the physician’s direct supervision 

  • 'Auxiliary personnel' means any individual acting under the supervision of a physician. Where a physician supervises auxiliary personnel to assist in rendering services to patients and includes the charges for their services in his/her own bills, the services of such personnel are considered 'incident to' if there is a physician’s service rendered to which the services of such personnel are an incidental part and there is direct supervision by the physician.

    • Services and supplies may also be covered when furnished as 'incident to' the professional services of a physician or other specified NPP as listed below:

    • Clinical Psychologists 
    • Clinical Social Workers
    • Clinical Nurse Specialists
    • Nurse Practitioners
    • Physician Assistants
    • Certified Nurse Midwives 
    • Mental Health Counselor
    • Marriage Family Therapists

     

    References