CMS Implements Previously Delayed "Incident To" Regulation
On July 24, 2005, the Centers for Medicare and Medicaid Services (CMS) announced that it would immediately implement the regulation requiring staff who provide services billed as occupational therapy services incident to the services of a physician to meet the qualification requirements for occupational therapists. The exception is state licensure unless it is required by state law.
The regulation should help to ensure that the care provided to patients will be delivered by qualified personnel providing authentic, high quality services.
Recent research conducted by CMS regarding the impending financial limitations on outpatient therapy services have emphasized the need to define the qualifications of those providing therapy services to help assure that precious therapy dollars are spent on bona fide therapy.
The effective date of the provision had been delayed due to an agreement between CMS and the National Athletic Trainer's Association (NATA), pending the resolution of NATA's lawsuit challenging the "incident to" regulation. On July 21, the court dismissed the NATA lawsuit so CMS has now implemented the challenged requirements.
You can view or download the Change Request implementing these provisions and read an accompanying Medlearn Matters article explaining this regulation.
The new requirements for occupational therapy services provided incident to physician services can be found in the regulations at 42 C.F.R. §410.10(b), 42 C.F.R. § 410.26, Medicare Pub. 100-02, ch. 15, § 60 and Change Request 3648 and are as follows:
- Therapists working in physician offices or group practices may provide services through their own private practice provider numbers or as employees of the physician practice through the physician's provider number.
- In order to provide and bill for therapy services, auxiliary personnel working incident to physicians must meet the same requirements as therapists, with the exception of having a license, unless required by state law. Therefore, physicians can no longer bill services provided by athletic trainers, massage therapists, recreation therapists, kinesiotherapists, low vision specialists, or any profession other than occupational therapy, physical therapy, or speech-language pathology, as therapy. Services provided by athletic trainers and so forth can no longer be billed by physicians as occupational, physical or speech-language pathology therapy.
Services of an OTA may not be billed incident to a physician; however, if an occupational therapist (OT) and OTA are both employed in a physician's office, the OT is enrolled in Medicare with an OTPP provider number, and the services of the OTA are directly supervised by the OT, the OTA's services may be billed by the physician group as OT services using the provider identification number of the enrolled OT.
For further information, see a previous related article " CMS Issues Medicare Benefit Policy Manual Clarification on Outpatient Therapy Services