Notice: This CMS-approved document has been submitted - Philips ...

CMS-1403-FC
supplier will be subject to the anti-markup payment
limitation in §414.50. If the performing physician does
not meet the “substantially all” services requirement of
Alternative 1, an analysis under the Alternative 2
requirements may be applied on a test-by-test basis to
determine whether the anti-markup payment limitation
applies. Under the Alternative 2 “site-of-service”
approach, only TCs conducted and supervised in and PCs
performed in the office of the billing physician or other
supplier by an employee or independent contractor physician
will avoid application of the anti-markup payment
limitation. Both the “substantially all professional
services” and “site-of-service” tests are measures of
whether a performing/supervising physician “shares a
practice” with the billing physician or other supplier.
With respect to Alternative 2, we believe that restrictions
regarding the location of the conducting and supervising of
the TC are essential to ensure that, if the test is to be
billed as performed by the billing physician or other
supplier, the billing physician or other supplier exercise
sufficient control and a proper nexus to the individuals
conducting and supervising the test. Requiring that the TC
be conducted and supervised in the office of the billing
physician or other supplier, under Alternative 2, creates
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