What are the two criteria that must be met to bill for incident-to services performed by a Non-Physician Provider (NPP)?

Billing for incident-to services performed by a Non-Physician Provider (NPP) requires two key criteria to be met to ensure compliance with Medicare regulations. One crucial requirement is that the supervising physician must be present in the office suite and must have established a treatment plan that the NPP is following. This oversight is essential to qualify for incident-to billing, as it demonstrates that the services provided are integrated into the physician's care plan, reflecting collaborative patient management.

The presence of the physician not only affirms the continuity of care but also upholds the requirement that these services must be part of an ongoing treatment regimen established by the physician. This guideline ensures that the patient receives comprehensive care while still allowing NPPs to perform certain services under the physician’s supervision.

While other options mention various aspects of service delivery, they do not encompass the critical regulatory requirements for incident-to billing. For instance, while services being routine is a common characteristic of incident-to services, it alone does not address the necessary supervisory relationship. Similarly, a patient referral by a specialist or the NPP's specific training, while relevant in other contexts, do not pertain to the stipulations governing incident-to services.