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CMS-1403-FC
other supplier. We are not persuaded that we should
disqualify the performing physician from sharing a practice
with the billing physician or other supplier if his or her
locum tenens or part-time arrangements do not involve
performing work for a billing physician or other supplier
engaged in the same specialty as the performing physician.
Immediately above, we address the issue of whether a
physician may share a practice with a billing physician or
other supplier despite furnishing some services through
other arrangements, including acting as a locum tenens
physician. In this paragraph, we address the “flip side”
of this issue, that is, whether a billing physician or
other supplier can avoid application of the anti-markup
payment limitation where a locum tenens physician is
substituting for a physician who does in fact perform
“substantially all” of his or her professional services
through the billing physician or other supplier. We wish
to clarify that, with respect to locum tenens situations
only, whether an arrangement satisfies Alternative 1
depends on whether the permanent physician (that is, the
physician for whom the locum tenens physician is
substituting) performs “substantially all” of his or her
professional services through the billing physician or
other supplier. For example, assume Physician A contracts
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