2006 proposed fee schedule - American Society of Clinical Oncology

Under section 1877 of the Act, a physician may not
refer a Medicare patient for certain designated health
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services (DHS) to an entity with which the physician (or an
immediate family member of the physician) has a financial
relationship, unless an exception applies. Section 1877 of
the Act also prohibits the DHS entity from submitting claims
to Medicare or billing the beneficiary or any other entity
for Medicare DHS that are furnished as a result of a
prohibited referral. Sections 1877(h)(6)(D) and (E) of the
Act define DHS to include “[r]adiology services, including
magnetic resonance imaging, computerized axial tomography
and ultrasound services” and “[r]adiation therapy services
and supplies.” This proposed rule would include diagnostic
and therapeutic nuclear medicine procedures under the DHS
categories for radiology and certain other imaging services
and radiation therapy services and supplies, respectively.
On January 9, 1998, we published a proposed rule
(63 FR 1659) that, among other things, proposed regulatory
definitions for the various DHS categories listed in the
statute. In that proposed rule, we proposed to include
nuclear medicine services in the definition of radiology
services. In the January 4, 2001 physician self-referral
Phase I final rule (66 FR 856), we defined “radiology and
certain other imaging services” and “radiation therapy
services and supplies” at §411.351. We did not include