MedPAC Recommends Eliminating “Incident to” Billing Provisions

The Medicare Payment Advisory Commission (MedPAC) has issued their annual report to Congress.  The report indicates the Commission voted unanimously to eliminate the Medicare “incident to” billing provisions.  The recommendation was largely made to reduce Medicare spending and allow the program to more easily identify nurse practitioner (NP) and physician assistant (PA) specialties, services rendered and more accurately analyze provider billing utilization.  Eliminating “incident to” billing is estimated to reduce Medicare spending by $50-$250 million dollars in the first year and save the program $1 billion to $5 billion over the first five years.

The recommendations, if adopted would require:

  • NPs and PAs to bill all services under their own NPI
  • No changes to state scope-of-practice requirements for physician supervision or collaboration
  • All NP and PA services to be reimbursed at 85% of the Medicare allowable

The MedPAC recommendations would substantially alter the current operations, practice models and revenues in most physician practices. 

The full MedPAC report can be found

We urge providers to read the MedPAC report in detail, as well as watch for additional notices from CMS, and have preliminary discussions within your organization regarding the potential impact of these recommendations to your operations and revenues.

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