As you’re probably aware, the main reason most medical practices bill services as incident to is because they want to collect 15% more pay. And that’s your right if you’re following the incident to billing guidelines. The main pitfall you need to avoid is violating the compliance regulations — and with so many new ones popping up all the time, that’s not easy.

Check out three potential compliance issues you might face if you don’t follow the incident to billing guidelines properly.

Compliance Issue 1: Hospital Patients

When a patient is in the hospital, the concept of incident to doesn’t apply. “Hospital and skilled nursing facility services cannot be billed as incident to at any time,” says Part B payer Novitas Solutions. If you bill an inpatient using incident to rules, you could find yourself under auditors’ scrutiny.

While the incident to billing guidelines restrict you from reporting incident to services in the inpatient setting, you’ll instead report split/shared services at the hospital. Whichever provider — the nonphysician provider or the physician — performs the substantive portion of the visit submits the claim under the split/shared rules for hospital claims.

Compliance Issue 2: The Doctor Isn’t Available

You can only report an NPP’s service as incident to if the physician is immediately available to provide assistance and direction if needed. In some cases, as of 2025, the physician may be available via telehealth. But if they’re not available at all and you bill incident to services, you could get into deep compliance trouble under the incident to billing guidelines. Many practices have faced steep fines and penalties after being audited if the provider wasn’t available when an incident to service was billed.

If the physician isn’t immediately available (either via telehealth, when allowed, or in person), you’ll need to bill the service under the NPP’s billing number and not the physician’s. You’ll collect 85% of the fee schedule amount for that service.

Compliance Issue 3: New Problems Are Treated

Under the incident to billing guidelines, services only qualify if the physician saw the patient first and established the care plan. As long as the NPP is following that care plan, incident to applies. Issues may arise when even established patients present for an incident to service but then have a new complaint. Since the NPP can’t follow an established care plan for a new problem, incident to won’t apply to that service.

Instead, the NPP can either treat the patient’s new problem and bill the service under their own NPI, or bring in the doctor for the new problem.