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CMS-1403-FC
more invasive than clinical laboratory tests such as
fingerstick for hematocrit or a dipstick urine.
Response: Billing physicians and other suppliers will
continue to be able to employ a physician specialist on a
part-time basis. Under Alternative 1, if the specialist
furnishes “substantially all” (at least 75 percent) of his
or her professional services through the billing physician
or other supplier, the specialist “shares a practice” with
the billing physician or other supplier. Because this rule
finalizes both proposed approaches, if an arrangement does
not satisfy the “substantially all” test of Alternative 1,
the billing of a TC or PC may still avoid application of
the anti-markup payment limitation if it meets, as
determined on a case-by-case basis, the “site-of-service”
requirements of Alternative 2. Alternatively, part-time
physicians can bill Medicare directly.
Comment: Some commenters contended that adoption of
Alternative 1 would interfere unfairly with the practice of
medicine by severely limiting physician practices’ right to
organize themselves as they see fit to deliver quality care
to their patients. These commenters stated that adoption
of Alternative 1 would prevent a group from hiring a part-
time pathologist, as is common for gastroenterology
practices that provide pathology services to their
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