Requirement Can be done by Independent Can be done by hospital-

pharmacy? based pharmacy?

Must take place in a non- Yes Yes
institutional setting (not
hospital or SNF)
Service must be part of the Yes Yes
normal course of treatment
for a diagnosis or illness
Can only be done by NPP Yes Yes
subsequent to initial
encounter
Care must occur under direct Yes, virtually2 Yes
supervision
Commonly rendered without Yes Yes
charge or included in
physician’s bill
Physician must participate in Yes Yes
and manage patient’s
treatment
Physician and NPP must be No Yes*
employed by the group entity *Could salary could be paid Do hospitals own outpatient
billing for the service by both office and pharmacy pharmacies?
Table 1: “Incident To” Billing Requirements1

Reference:
1
MLM Matters Number: SE0441 “Incident to” Services. Centers for Medicare and Medicaid Services. August 23, 2016. Available
at: https://www.cms.gov/outreach-and-education/medicare-learning-network-mln/mlnmattersarticles/downloads/se0441.pdf.
2
Physicians and Other Clinicians: CMS Flexibilities to Fight COVID-19. Centers for Medicare & Medicaid Services. April 2020.
Available at https://www.cms.gov/files/document/covid-19-physicians-and-practitioners.pdf.