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

CMS-1403-FC
space in which the ordering physician performs
substantially the full range of patient care services that
the ordering physician provides generally). We are adding
to Alternative 2 the requirement, with respect to the TC,
that the physician supervising the TC be an owner,
employee, or independent contractor of the billing
physician or other supplier, and, with respect to the PC,
that the physician performing the PC be an employee or
independent contractor of the billing physician or other
supplier. We are doing this in order to simplify our rules
and to avoid having a separate basis for imposing an anti-
markup payment limitation for TCs supervised and PCs
performed by outside suppliers. We explain our rationale
for this change in the next paragraph.
We are not finalizing a definition of outside
supplier, and instead we are deleting references to a
“purchased” test or interpretation in §414.50 because they
are unnecessary, as explained below. We note that section
1842(n)(1) of the Act requires us to impose an anti-markup
payment limitation on diagnostic tests that are performed
or supervised by a physician who does not share a practice
with the billing physician or other supplier.
Traditionally, we have interpreted section 1842(n)(1) of
the Act as applying to purchased TCs from an outside
427