Medicare Limits Who Can Perform Incident-to Therapy Services

As of July 25, 2005,  Medicare began paying physicians for physical, occupational, and speech pathology therapy performed in their office as an incident-to service ONLY if it was done by a licensed therapist or an assistant therapist supervised by a licensed therapist.

Previously, Medicare paid physicians for incident-to therapy services even when other providers, such as massage therapists, athletic trainers, or physical therapy aides, performed it. However, Medicare no longer considers physician supervision of these auxiliary providers to be sufficient.

Under the new rules, Medicare will reimburse physicians for therapy services performed by therapy assistants only if:

  • The physician employs both the therapist and the therapy assistant in his or her office,
  • The therapist (not the physician) supervises the assistant, and
  • The therapist is enrolled in Medicare.

Nonphysician practitioners are still allowed to furnish therapy services incident to the physician's service.

Therapy generally is a big compliance risk area and a frequent target of Medicare auditors, according to the American Society of Interventional Pain Physicians. You risk false claims accusations if you bill Medicare for incident-to therapy that isn't provided by a licensed physical therapist.

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