Incident-to Services

A physician, CP, CNS, NP, PA, or CNM may have outpatient psychiatric services and supplies furnished incident to his or her professional service. To be covered under the Incident to provision, the following requirements must be met:

• The services and supplies must be an integral part of the patient’s normal course of treatment during which the physician or other listed NPP has personally performed an initial service and remains actively involved in the course of treatment;
• The services and supplies are commonly furnished without charge (included in the physician’s or other listed NPP’s bill); the services and supplies are an expense to the physician or other listed NPP;
• The services and supplies are commonly furnished in the physician’s or other listed NPP’s office or clinic; and
• The physician or other listed NPP provides direct supervision, which means he or she is present in the office suite and immediately available if needed.
• Services and supplies furnished by CPs, CSWs, CNSs, NPs, PAs, and CNMs may also be covered when furnished as an incident to the professional services of a physician or other specified NPP if they would have been covered when furnished incident to the services of a MD or a DO.
• We may cover ancillary CSW, MFT, MHC services when provided as auxiliary personnel incident to the personal professional services of a physician, a CP, a CNS, an NP, a PA, or a CNM.
• We don’t cover services provided incident to CSWs, MFTs or MHCs personal professional services. However, CSWs, MFTs, and MHCs may continue provide services as auxiliary personnel incident to a physician’s or certain NPP’s personal professional services.

Revised 3/19/2024