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CMS-1403-FC
programs, we hope to acquire information that will better
inform the development of an exception that is sufficiently
flexible to encourage the development and implementation of
beneficial, nonabusive incentive payment and shared savings
programs that foster high quality, cost-effective care for
our beneficiaries.
2. Changes to Reassignment Rules Related to Diagnostic
Tests (Anti-Markup Provisions)
Section 1842(n)(1) of the Act requires us to impose a
payment limitation on certain diagnostic tests where the
physician performing or supervising the test does not share
a practice with the physician or other supplier that bills
for the test. We implemented section 1842(n)(1) of the Act
by applying an “anti-markup” payment limitation to
technical components (TCs) of diagnostic tests purchased
from an outside supplier, which has long appeared in our
regulations in §414.50 and which is applicable to
diagnostic tests covered under section 1861(s)(3) of the
Act and paid for under 42 CFR part 414 (other than clinical
diagnostic laboratory tests paid under section
1833(a)(2)(D) of the Act, which are subject to the special
billing rules set forth in section 1833(h)(5)(A) of the
Act). In the CY 2008 PFS final rule with comment period
(72 FR 66222), relying on section 1842(n)(1) of the Act,
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