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Incident to Services

Provider Type

  • Physicians

Counties Covered

  • Fresno
  • Kern  
  • Kings
  • Los Angeles
  • Madera
  • Sacramento
  • San Diego 
  • San Joaquin
  • Stanislaus
  • Tulare

The Centers for Medicare and Medicaid Services (CMS) defines "incident to" services as those services furnished as an integral, although incidental, part of the physician's personal professional services.

A physician may be reimbursed for "incident to" services performed by auxiliary personnel only when an employer relationship exists between the physician and auxiliary personnel.

When these procedures are performed in an inpatient or outpatient hospital setting, they are denied as "incident to" the physician's service.

Health Net administers the CMS list of procedures that are "incident to" the physician's professional services when performed in a hospital setting.

The following are examples of services on the CMS "incident to" services list:

  • Immunizations and therapeutic injections
  • Chemotherapy administration
  • IV infusion
  • Allergy testing and immunotherapy

For a complete list of codes/services, refer to the CMS website at www.cms.gov. The rationale for "incident to" services can be found in Publication 100-4 Medicare Claims Processing, Chapter 12, Section 30.5.

Health Net does not require documentation at the time of claim submission; however, in the event the claim is audited, documentation may be required.

Supporting Sources

  • CMS National Policy
Last Updated: 10/30/2019