Services and Supplies

A Physician Assistant (PA), Nurse Practitioner (NP), Clinical Nurse Specialist (CNS), and Certified Nurse-Midwife (CNM) each have their own benefit categories and may provide services without direct physician supervision and bill directly for these services. However, when their services are provided as auxiliary personnel (under direct physician supervision) they may be covered as incident to services, in which case the incident to requirements would apply.

For purposes of this section, physician means physician or other practitioner (physician, physician assistant, nurse practitioner, clinical nurse specialist, nurse-midwife) authorized by the Social Security Act to receive payment for services incident to his or her own services.

To be covered incident to the services of a physician or other practitioner, services and supplies must be:

• An integral, although incidental, part of the physician’s professional service;
  
  
• Commonly rendered without charge or included in the physician’s bill;
  
  
• Of a type that are commonly furnished in physician’s offices or clinics; and
  
  
• Furnished by the physician or by auxiliary personnel under the physician’s direct supervision.