Payment for Incident to Services and Supplies

120.3 - Payment for Incident to Services and Supplies (Rev. 239, Issued: 01-09-18, Effective: 1-22-18, Implementation: 1-22-18) Services that are covered by Medicare but do not meet the requirements for a medically necessary or qualified preventive health visit with an RHC or FQHC practitioner (e.g., blood pressure checks, allergy injections, prescriptions, nursing services, etc.) are considered incident to services. The cost of providing these services may be included on the cost report, but the provision of these services does not generate a billable visit. Incident to services provided on a different day as the billable visit may be included in the charges for the visit if furnished in a medically appropriate timeframe. Incidental services or supplies must represent an expense incurred by the RHC or FQHC. For example, if a patient purchases a drug and the physician administers it, the cost of the drug is not covered and cannot be included on the cost report. If a Medicare-covered Part B drug is furnished by an RHC or FQHC practitioner to a Medicare patient as part of a billable visit, the cost of the drug and its administration is included in the RHC’s AIR or the FQHC’s PPS payment. RHCs and FQHCs cannot bill separately for Part B drugs or other incident to services or supplies.