How are pharmacists reimbursed for services that are provided “incident to” physician services?
“Incident to” physician services is a reimbursement strategy in which a physician bills for a non-physician service. There are strict criteria for using the “Incident to” strategy. The Medicare Manual and the CMS web page will have the most up to date criteria for utilizing this billing strategy or by searching the CMS site. Since pharmacists are not recognized as providers by CMS, Medicare patients are normally billed for a level 1 (99211) visit. Other payers may reimburse at higher levels. A number of services are provided in this manner by pharmacists and include anticoagulation monitoring, diabetes management, lipid management, smoking cessation, polypharmacy consults, etc. A comprehensive discussion of billing is beyond the scope of these FAQs, but many resources are available to pharmacists who may be considering such an arrangement.
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