Name of Manual - Blue Cross and Blue Shield of Minnesota

Claims Filing
Employment As defined by CMS, the non-physician performing an “incidentto”
service may be a part-time, full-time or leased employee of the
supervising physician group practice or the legal entity that
employs the supervising physician. A leased employee is a nonphysician
working under a written employee leasing agreement,
which provides that:
The non-physician, although employed by the leasing
company, provides services as the leased employee of the
physician or other entity; and
The physician or other entity has control over all actions taken
by the leased employee with regard to medical services
rendered to the same extent that the physician or other entity
would have such control if the leased employee were directly
employed by the physician or other entity.
To satisfy the employment requirement, the non-physician must be
considered an employee of the supervising physician or other
entity under the common law test of an employer/employee
relationship.
Services provided by auxiliary personnel not employed by the
physician, physician group practice, or other legal entity are not
covered as incident to a physician’s service.
Incident To “Incident to” physician’s professional services means that the
services or supplies are furnished as an integral, although
incidental, part of the physician’s personal professional services in
the course of diagnosis or treatment or an injury or illness.
The practitioner’s service must be furnished as an integral part
of the physician’s personal professional service in the course of
diagnosis or treatment of an illness or injury.
An employee of the physician must render service under the
physician’s direct supervision.
The physician must perform the initial and subsequent service
with a frequency that reflects his/her active participation in
managing the course of treatment.
Practitioners who are issued individual provider numbers are
considered incident to the physician when performing services
within the same encounter on the same day as the physician.
Incident to services are applicable in the office place of service
only.
8-44 Blue Cross and Blue Shield of Minnesota Provider Policy and Procedure Manual (05/10/12)