Doctors Can Bill Pharmacist Services 'Incident-To,' CMS Says

The federal government has taken another step to make the patient-centered medical home financially viable. Medical practices have explicit permission to bill Medicare for the services of a pharmacist on an incident-to basis.

Pharmacists work directly with patients at both large integrated health systems such as Kaiser Permanente as well as a growing number of small, primary care practices. Their duties range from providing medication reconciliation and patient education to administrating immunizations and tests such as spirometry.

A pharmacist working alongside a physician is just the kind of teamwork envisioned by the Affordable Care Act, which promotes the medical-home model. It consists of a diverse group of healthcare professionals — typically led by a physician — that delivers coordinated, continuous care, especially for patients with chronic illnesses.

However, some physicians have wondered if and how they should charge Medicare for the work of in-house pharmacists. One option is billing for their services as incidental to what a physician normally does, as if the physician had personally rendered them. Simply put, a physician is charging for someone else's services under his or her own Medicare provider number.

Physicians frequently rely on the incident-to method to get reimbursed for the work of nurse practitioners and physician assistants. Medicare pays 100% of what it would normally pay a physician, as long as certain requirements, such as direct supervision of auxiliary personnel, are met. They can be an outright employee, a leased employee, or an independent contractor.

Go to top