Part B - Medical Insurance

Covered Part B services include, but are not limited to, the following:
Physician services such as surgery, consultations, office visits, institutional calls
Services and supplies furnished incident to physician professional services
Outpatient hospital services furnished incident to physician services
Outpatient diagnostic services furnished by a hospital
Outpatient physical therapy services
Outpatient occupational therapy services
Outpatient speech-language pathology services
Diagnostic x-ray tests, laboratory tests, and other diagnostic tests.
X-ray, radium, and radioactive isotope therapy services.
Surgical dressings and splints, casts, and other devices used for reduction of fractures and dislocations.
Rental or purchase of durable medical equipment for use in the beneficiary’s home.
Ambulance services.
Certain prosthetic devices that replace all or part of an internal body organ.
Leg, arm, back, and neck braces and artificial legs, arms, and eyes.
Certain medical supplies used in connection with home dialysis delivery systems.
Ambulatory Surgical Center services and
Preventive services.
INCIDENT TO PROVISION
To be covered incident to the services of a physician, services and supplies must meet the following four requirements:
1) commonly furnished in physicians’ offices or clinics
Services and supplies commonly furnished in physicians’ offices are covered under the incident to provision. Charges for these services and supplies must be included in the physician’s bill. To be covered, supplies (including drugs and biologicals) must be an expense to the physician or legal entity billing for the services or supplies.
Medicare Physician Guide: A Resource for Residents, Practicing Physicians and Other Health Care Professionals 49
2) Furnished by the physician or auxiliary personnel under the direct personal supervision of a physician
Services billed as incident to the services of a physician may be furnished by auxiliary personnel or non-physician practitioners under the required level of supervision. Auxiliary personnel are individuals who act under the supervision of a physician
regardless of whether the individual is an employee, leased employee, or independent contractor of the physician or of the legal entity that employs or contracts with the physician. A physician may also have the services of certain NPPs covered as incident to his or her professional service. These NPPs include the following:
Audiologists;
Certified nurse midwives;
Certified registered nurse anesthetists;
Clinical nurse specialists;
Clinical psychologists;
Clinical social workers;
Nurse practitioners;
Occupational therapists;
Physical therapists; and
Physician assistants.
The direct supervision for any service, including evaluation and management (E/M) services, can be furnished by any member of the group who is physically present on the premises and is not limited to the physician who has established the patient’s plan of care. Direct supervision in the office setting means that the physician is present in the office suite and immediately available to furnish assistance and direction throughout the performance of the service.
Services furnished by auxiliary personnel outside the office setting (e.g., in a
beneficiary’s home or in an institution other than a hospital or Skilled Nursing Facility are covered incident to a physician’s service only if there is personal supervision by the physician. Personal supervision means that a physician is physically in
attendance in the same room during the performance of the procedure.
3) Commonly furnished without charge or included in the physician’s bill
Incident to services or supplies must represent an expense incurred by the physician or legal entity billing for the services or supplies.
4) An integral, although incidental, part of the physician’s professional service
the physician must have furnished a personal professional service to initiate the course of treatment that is being furnished by the NPP as an incidental part.