Physician's Office within an Institution Coverage of Services and Supplies Incident to a Physician's Services

Medicare will cover services and supplies incident to a physician's professional services in an office located within an institution only when the office is a separately identified area used solely as the physician's office, auxiliary personnel are office staff, supply costs are borne by the physician's practice, and services outside the office area are directly supervised with a physician personal professional service. Services or equipment outside the scope commonly furnished in physician offices, services by institution staff, lack of direct supervision, or failure to distinguish office practice from the institution (including when the physician is owner/administrator) are not covered under the incident-to rules; MACs will closely review high-volume or frequent service patterns for medical necessity.

"Services and supplies furnished in a physician's office within an institution are covered when they meet the Medicare 'incident to a physician's professional service' criteria (Medicare Benefit Pol..."