Medicare, On the Job, Professional Identity

Medical Assistants and Incident-to Billing

What is meant by the statement that the services of a medical assistant must be billed “incident to” the services of the delegating physician for the physician to be reimbursed for the medical assistant’s services under Medicare?

Legally, medical assistants work under direct/onsite provider (e.g., physician, nurse practitioner, physician assistant) supervision and authority in outpatient settings. Medical assistants do not have National Provider Identifier (NPI) numbers because they are not reimbursed directly by Medicare for their services. Rather, their services may only be billed and reimbursed incident to the services of the delegating provider.

Note the following from the Medicare Benefit Policy Manual:

Incident to a physician’s professional services means that the services or supplies are furnished as an integral, although incidental, part of the physician’s personal professional services in the course of diagnosis or treatment of an injury or illness. …

Auxiliary personnel means any individual who is acting under the supervision of a physician, regardless of whether the individual is an employee, leased employee, or independent contractor of the physician, or of the legal entity that employs or contracts with the physician. …

Thus, where a physician supervises auxiliary personnel to assist him/her 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 the physician’s service if there is a physician’s service rendered to which the services of such personnel are an incidental part.

For more information, see my Public Affairs article from the March/April 2018 CMA Today: “Medicare CCM and TCM Programs: Defining Medical Assistants’ Roles and Services.”

5 thoughts on “Medical Assistants and Incident-to Billing”

  1. How does this fee for services rendered calculate with years of experience and fee schedules? Seems like providers bank big dollars off of highly trained/experienced CMA.

    1. Thank you for your question. The Medicare reimbursement is not affected by the years of experience of the medical assistant providing the incident-to services. Indeed, providers and patients benefit greatly from services provided by a knowledgeable and competent CMA (AAMA)!

      Donald A. Balasa, JD, MBA
      Chief Executive Officer, Legal Counsel
      American Association of Medical Assistants
      Ph: 800/228-2262 | Fax: 312/899-1259 | http://www.aama-ntl.org
      The CMA (AAMA): Health Care’s Most Versatile Professional®

  2. Hello Attorney Balasa,

    Can a Medical Assistant, certified, registered or not, phone in new narcotic orders for suboxone , bunavail or other narcotics used in a medication treatment program? In offices around the country, MAs call in refills but I was not aware that they could call in a new order as proxy to the provider.

    Does this depend upon state regulations or is it covered by the MA scope of practice?

    Thank you,

    Patricia A. Walker, RN, MSN
    Nurse Manager
    Department of Family and Community Medicine
    Meharry Medical College
    1810 Albion, Suite 300
    Nashville, TN 37208
    615-327-6385 ph, 615-327-5858 fax

    1. Thank you for your question. The legality of physicians assigning to medical assistants the transmission of prescription orders varies (in some cases, significantly) from state to state. I would be happy to research the Tennessee law if you would like.

      Donald A. Balasa, JD, MBA
      Chief Executive Officer, Legal Counsel
      American Association of Medical Assistants
      Ph: 800/228-2262 | Fax: 312/899-1259 | http://www.aama-ntl.org
      The CMA (AAMA): Health Care’s Most Versatile Professional®

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out /  Change )

Google+ photo

You are commenting using your Google+ account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s