To qualify under the rules for these "incident to" services, the physician and support professional must satisfy a number of criteria.
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Physicians who want their practices to thrive in a managed care environment recognize that a key to success is effective delegation of responsibility.
I have known of situations in which PAs do detailed history and exam procedures or second- and third-level office visits, and where support professionals have given injections at a physician's branch office, without any on-site physician.
Thus, it is not clear when, if ever, you may bill for a higher level of services provided by a support professional, unless the services qualify under the "incident to" rules or their exceptions.
Medicare does pay specifically for services provided by a nonphysician during a minimal office visit with an established patient, even when a physician isn't present.
However, officials in the Office of Coverage and Eligibility Policy have noted that the types of services thus covered by Medicare depend on the patient's history, the prior involvement of the physician and the level of services provided.
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None of this is spelled out in detail in the Medicare rules.