Reversing an initial plan to cut payment, Aetna says it will continue to pay nonphysician practitioners (NPPs) 100% of the eligible billable amount when the service is billed “incident-to” physician supervision.
Based on an earlier announcement in January, Texas Medicine Today previously reported that starting April 1, Aetna had intended to pay physician practices just 85% of the allowed amount for services provided by NPPs (as indicated by modifiers SA or SB), regardless of whether they billed directly or “incident-to” physician supervision.
At the time, the Texas Medical Association had expressed grave concern the original move was “essentially [Aetna] getting rid of incident-to billing,” Director of Physician Payment Services Carra Benson said.
However, Aetna’s Feb. 10 reversal preserves NPPs’ ability to fully bill under a supervising physician’s name and National Provider Identifier (NPI) for services incidental to the physician’s diagnosis and treatment of an injury or illness. Services billed incident-to must be conducted in the same office suite where the physician is present and available to intervene if needed.
NPPs who bill directly under their own name and NPI will continue to receive payment at only 85% of the fee schedule.
Meanwhile, Aetna is retaining the requirement for NPPs to credential with the payer to continue to bill for services, whether under their own name or a physician’s. The change will apply to both commercial and Medicare patients and follow similar moves by Blue Cross Blue Shield last year.
Ms. Benson encourages supervising physicians to have their NPPs credentialed by individual payers. Doing so avoids disruptions in billing or coverage and provides a safety net against lost revenue if an NPP visit billed under the physician’s NPI number is disqualified for any reason, she says.
Credentialing involves collecting and verifying information about an NPP’s professional qualifications. This includes, but is not limited to:
- Certification or registration to practice in a health care field; and
To speak directly with TMA billing and coding staff, visit TMA’s comprehensive Physician Payment Resource Center. For payer updates, visit TMA’s Health Plan News page.
Last Updated On
February 12, 2025
Originally Published On
February 12, 2025