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CMS-1403-FC
“either/or” approach to the two proposed alternatives.
That is, a billing physician or other supplier can avoid
application of the anti-markup provisions by meeting either
the “substantially all” professional services approach of
Alternative 1 or, on a case-by-case basis, the “site-of-
service” approach of Alternative 2, which are set forth in
revised §414.50(a)(2)(ii) and (iii). We believe that
compliance with either one of the two approaches finalized
in this rule will further our goal of reducing the
potential for overutilization and other program or patient
abuse while providing sufficient flexibility for the
industry.
Comment: One commenter contended that a “one
building” “site-of-service” standard is not a realistic
means of ensuring proper billing arrangements, as large
single specialty practices often span beyond one building.
Another commenter remarked that the site-of-service
alternative should not be finalized because it would be
problematic for groups where specimens are collected at
multiple sites but pathology diagnostic testing services
are done at a separate location owned or leased by the
group (the “hub-and-spoke” arrangement). Some
cardiologists also expressed concern that interpretations
of EKGs and other diagnostic testing services may be
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