Services Furnished by Physicians in Providers, Supervising Physicians in Teaching Settings, and Residents in Certain Settings

Basis and scope.

This provision establishes the regulatory basis and scope for Medicare payment rules regarding physician services furnished in hospital and provider settings.

Scope.

This provision outlines the general conditions for Medicare fee schedule payment for physician services furnished to beneficiaries in provider settings.

Conditions for fee schedule payment for physician services to beneficiaries in providers.

This provision sets forth the specific requirements that must be met for physician services to be paid on a fee schedule basis when furnished in a provider setting.

Amounts of payment for physician services to beneficiaries in providers.

This provision specifies the methodology for determining payment amounts for physician services furnished to beneficiaries in provider settings, including teaching hospitals and ESRD facilities.

Conditions for payment: Medically directed anesthesia services.

This provision defines the specific conditions and documentation requirements for Medicare payment of medically directed anesthesia services.

Conditions for payment: Radiology services.

This provision outlines the requirements for Medicare fee schedule payment for radiology services furnished by physicians in provider settings.

Conditions for payment: Physician pathology services.

This provision specifies the conditions for Medicare payment for physician pathology services, including clinical consultations and laboratory interpretations.

Conditions for payment: Split (or shared) visits.

This provision defines the requirements for Medicare payment when evaluation and management visits are performed jointly by a physician and a nonphysician practitioner.

Scope.

This provision defines the scope of rules governing payment for physician services in teaching settings, including reasonable cost and fee schedule mechanisms.

Definitions.

As used in this subpart—

Election of reasonable cost payment for direct medical and surgical services of physicians in teaching hospitals: General provisions.

This provision outlines the requirements and election process for teaching hospitals to receive Medicare payment for physician services on a reasonable cost basis rather than a fee schedule.

Determining payment for physician services furnished to beneficiaries in teaching hospitals.

This provision establishes the Medicare payment methodologies, reasonable cost definitions, and apportionment requirements for physician services, including supervision of residents and volunteer services, in teaching hospital settings.

Payment to a fund.

This provision outlines the conditions under which Medicare payments for voluntary physician services in teaching hospitals may be made to a designated fund rather than individual physicians.

Conditions for payment on a fee schedule basis for physician services in a teaching setting.

Services meeting the conditions for payment in § 415.102(a) furnished in teaching settings are payable under the physician fee schedule if—

Physician fee schedule payment for services of teaching physicians.

This provision establishes the requirements for teaching physician presence and documentation necessary to receive Medicare physician fee schedule payments when residents participate in services.

Exception: Evaluation and management services furnished in certain centers.

This provision defines the criteria under which residents may furnish evaluation and management services without the physical presence of a teaching physician in specific outpatient settings.

Renal dialysis services.

In the case of renal dialysis services, physicians who are not paid under the physician monthly capitation payment method (as described in § 414.314 of this chapter) must meet the requirements of §§ 415.170 and 415.172 (concerning physic...

Anesthesia services.

This provision specifies the requirements for teaching anesthesiologist presence and documentation to qualify for Medicare physician fee schedule payments.

Teaching setting requirements for the interpretation of diagnostic radiology and other diagnostic tests.

This provision outlines the conditions under which Medicare payment is made for the interpretation of diagnostic radiology and other tests performed by residents in teaching settings.

Psychiatric services.

This provision specifies the requirements for teaching physician presence and documentation for psychiatric services furnished by residents in teaching settings.

Conditions of payment: Assistants at surgery in teaching hospitals.

This provision outlines the specific conditions under which Medicare makes fee schedule payments for assistant-at-surgery services in teaching hospitals with approved GME programs.

Services of residents in approved GME programs.

This provision specifies that services furnished by residents in approved GME programs are excluded from physician fee schedule payments and are instead payable as hospital services.

Services of residents not in approved GME programs.

This provision establishes that services of residents not in approved GME programs are paid to the hospital on a Part B reasonable cost basis.

Services of residents in skilled nursing facilities and home health agencies.

This provision outlines the conditions for Medicare Part A and Part B payment for resident services furnished in skilled nursing facilities and home health agencies.

Services of residents in nonprovider settings.

This provision details the two methods for paying for resident patient care activities in nonprovider settings, either through direct GME payments or the physician fee schedule.

Services of moonlighting residents.

This provision defines moonlighting services for residents and establishes the criteria for payment under the physician fee schedule versus GME payment rules.

Scope.

This provision defines the scope of the subpart regarding payment by fiscal intermediaries to providers for services furnished by physicians.

General payment rules.

This provision outlines the conditions under which costs incurred by a provider for physician services are considered allowable for Medicare payment.

Allocation of physician compensation costs.

This provision mandates the methodology for allocating physician compensation costs among different service categories and establishes recordkeeping requirements for providers.

Limits on compensation for physician services in providers.

CMS establishes reasonable compensation equivalency limits for physician services provided in hospitals, subject to specific exclusions and adjustment methodologies.