Services and Supplies Furnished “Incident to” Physician’s

120 - Services and Supplies Furnished “Incident to” Physician’s Services (Rev. 239, Issued: 01-09-18, Effective: 1-22-18, Implementation: 1-22-18) “Incident to” refers to services and supplies that are an integral, though incidental, part of the physician’s professional service and are: • Commonly rendered without charge and included in the RHC or FQHC payment; • Commonly furnished in an outpatient clinic setting; • Furnished under the physician’s direct supervision; except for authorized care management services which may be furnished under general supervision; and • Furnished by RHC or FQHC auxiliary personnel. Incident to services and supplies include: • Drugs and biologicals that are not usually self-administered, and Medicare- covered preventive injectable drugs (e.g., influenza, pneumococcal); • Venipuncture; • Bandages, gauze, oxygen, and other supplies; or • Services furnished by auxiliary personnel such as a nurse, medical assistant, or other clinical personnel acting under the supervision of the physician. Supplies and drugs that must be billed to the DME MAC or to Part D are not included. NOTE: Payment for Medicare-covered Part B drugs that are not usually self- administered and are furnished by an RHC or FQHC practitioner to a Medicare patient are included in the RHC AIR or the FQHC’s PPS per diem payment. However, Section 1861(s)(2)(G) of the Act provides an exception for RHCs when a physician prepares a specific formulation of an antigen for a patient if the antigen is “forwarded to another qualified person (including a rural health clinic) for administration to such patient…, by or under the supervision of another such physician.” An RHC practitioner (physician, NP, PA, or CNM) acting within their scope of practice may administer the drug and the cost of the administration may be included on the RHC's cost report as an allowable expense. The cost of the antigen prepared by a physician outside of the RHC is not included in the RHC AIR. Physicians who prepare an antigen that is forwarded to an RHC should submit a claim for the antigen in accordance with instructions from the contractor that processes their Part B claims and applicable CMS requirements.