“Incident to” Services

Medicare allows for the billing of “incident to” services performed by ancillary personnel under the supervision of a qualified Medicare provider. Services furnished “incident to” a psychologist’s services are covered by Medicare if they meet specified requirements outlined in the Medicare Carriers Manual. These requirements state that the services must be: 

• Mental health services that are commonly furnished in a psychologist’s office.
• An integral, although incidental, part of the professional services performed by the psychologist.
• Performed under the direct personal supervision of the psychologist.
• Either furnished without charge or included in the psychologist’s bill.  

Psychologists should closely review their MAC’s local coverage determinations (LCDs) for any limitations or restrictions on “incident to” services. You can view the LCDs online.

Effective Jan. 1, 2015, CMS required that all “incident to” services and supplies must be furnished in accordance with applicable state law. The definition of auxiliary personnel was also clarified to require that the individual furnishing “incident to” services must meet any applicable requirements to provide such services, including licensure, imposed by the state in which the services are furnished.

Any person performing an “incident to” service must be a part-time, full-time or leased employee of the psychologist or an employee of the legal entity that employs the supervising psychologist.

A leased employee is a person working under a written employee leasing agreement which provides that:

• The ancillary personnel, although employed by the leasing company, provides services as a leased employee of the psychologist (or the entity that employs the psychologist).
• The psychologist (or the psychologist’s employer) exercises control over all actions taken by the leased employee to the same extent as the psychologist/employer would if the leased employee was directly employed by the psychologist/employer.

Medicare does not allow for services provided by interns or postdoctoral graduate students to be billed under the “incident to” provisions. Medicare considers services furnished by interns or postdoctoral graduate students to be training and therefore not eligible for Part B funding.