CMS Pub. 100-02, ch. 13, § 120

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.