In the Pennsylvania Medicare Part B December 1, 2002, Medicare Report, page 30, HGSA published an article titled Psychotherapy Is Not Billable "Incident To." This article defined "incident to" services as those services and supplies furnished as an integral, although incidental, part of the physician's personal professional services in the course of diagnosis or treatment of an injury or illness. The article further explained that to be covered "incident to" the services of a physician, 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 is commonly furnished in physicians' offices or clinics;
- Furnished under the physician's direct supervision; and
- Furnished by the physician or by an auxiliary personnel acting under the direct supervision of a physician, regardless of whether the individual is an employee, leased employee, or independent contractor of the physician.
The article further stated that the Centers for Medicare and Medicaid Services (CMS) issued a statement in a recent letter to Medicare Carrier Medical Directors that, "...psychotherapy services are self-contained and too significant to be considered an incidental service." Therefore, psychotherapy is considered a stand-alone service and is not merely an incidental part of a patient's care. Consequently, psychotherapy should not be reported "incident to" even if the above bulleted items are supported.Since the publication of this article, HGSAdministrators has been contacted by several specialty societies and other interested parties expressing their concerns regarding how this directive may potentially affect access to care for Pennsylvania's Medicare population in need of psychotherapy services.
HGSAdministrators acknowledges this concern and realizes the impact that this issue potentially may have on those Medicare beneficiaries receiving their care in Pennsylvania. Therefore, until HGSAdministrators receives clarification from CMS regarding this issue, practitioners who have historically provided psychotherapy services to their Medicare patients utilizing the Medicare "incident to" benefit and regulations, and believe that Medicare non-coverage of such services would limit access to "reasonable and necessary" care of the Medicare patient(s), should clearly document their concerns and rationale in the patients' medical records (in addition to each patient's clinical record documentation) and continue to provide the service. This directive may be applied to services provided on or after December 1, 2002, and will remain in effect until other instructions and/or clarifications are published by this Medicare contractor.
Psychotherapy services provided "incident to" must be in keeping with the above stated "incident to" guidelines, as well as all national regulations, statutes, Local Medical Review Policies (e.g. LMRP V-41D on Psychiatric Therapeutic Procedures), and CMS directives, to include the recent CMS Transmittal, AB-03-037, Change Request 2520, published on our website on March 28, 2003.