CMS rescinds changes to incident-to billing rules 

On May 30, 2008 the Centers for Medicare & Medicaid Services (CMS) announced its decision to rescind a recent transmittal on incident-to billing guidance. This action is a direct result of advocacy efforts led jointly by the Medical Group Management Association (MGMA) and the American Medical Association. This effort, supported by 30 other physician organizations, prompted CMS to consider the issue more thoroughly. In addition to rescinding the transmittal, the agency announced its intention to release a new transmittal at a future date.
Despite CMS' contention that Transmittal 87 served only to clarify the agency's "incident to" billing rules, it would have, in fact, changed them significantly. The policy, originally released with little notice and education for providers, included:

  • Increased reliance on the discretion of Medicare contractors to determine whether a service by a nonphysician provider can be billed incident to a physician's care
  • A narrow definition of "clinic," which appears to limit the provision of incident-to services in clinics other than those that are physician-owned and operated
  • Administratively burdensome documentation requirements, such as explicit documentation in patient medical records of credentials of clinical personnel performing incident-to services

CMS intends to examine its "incident to" billing guidance and has not ruled out changes to these rules. MGMA will continue to work with CMS and the physician community to ensure that any changes to "incident to" billing rules make sense and that the agency will provide adequate notice and education before the new policy takes effect.

Related Links

Physician community's letter to CMS Adobe PDF
Notice rescinding the Transmittal  
Removal of the MLN Matters article on the Transmittal 


Contact Information

Contact Congress Contact Congress


Not a Member?

Members have the opportunity to interact directly with the MGMA Government Affairs staff. 

Sign up for a 30-day MGMA trial!

Benefits of becoming an MGMA member:

  • Weekly Washington Connection e-newsletter
  • Access to expert Government Affairs staff
  • Timely resources and articles