Can incident to occur in place of service (POS) 19 or 22 (outpatient hospital)?

Answer:
No. Incident to services are limited to the office setting (place of service (POS) 11). However, if a provider establishes an office in a larger outpatient setting, the "incident to" services and requirements are confined to this discrete part of the facility designated as his/her office. 

Reminder: 

  • Hospital-Based Physician (employees of the hospital)
    • The hospital is billing and "incident to" does not apply
    • Submit POS 19 or 22
  • Group of physicians (not employees of the hospital) and the office is confined to the discrete part of the facility
    • The physicians are incurring the expense and "incident to" would apply
    • Submit POS 11 (not POS 19 or 22)

Resources:

Contact Palmetto GBA JM Part B Medicare

Email Part B

Contact a specific JM Part B department

Provider Contact Center: 855-696-0705

TDD: 866-830-3188

Other Palmetto GBA Sites

Palmetto GBA Home

DMEPOS Competitive Bidding Program

Jurisdiction J Part A MAC

Jurisdiction J Part B MAC

Jurisdiction M Part A MAC

Jurisdiction M Part B MAC

Jurisdiction M Home Health and Hospice MAC

MolDX

National Supplier Clearinghouse MAC

PDAC

RRB Specialty MAC Providers

RRB Specialty MAC Beneficiaries

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