April 27, 2017

Question:
Whose NPI number do we bill under when a PA sees the patient in the office under the “incident to” rules for Medicare?  We bill under the NPI number of the physician who wrote the original treatment plan for the patient. Is that correct?

Answer:
No, when billing “Incident to,” bill under the NPI number of the physician in the office who is supervising. The guidelines are very clear that a physician must be present in the “office suite”. The PA’s visit must be billed under the physician who is in the “office suite” at the time the PA is managing the care of the patient which may not necessarily be the physician who documented the original treatment plan.

*This response is based on the best information available as of 04/27/17.