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CMS-1403-FC
limited by the proposed site-of-service approach. One
commenter provided the example of a group that has three
offices but only one with a CT scanner. The commenter
noted that under the site-of-service approach, the anti-
markup provision would apply to tests ordered and
supervised by physicians employed by the group unless the
physicians worked in the same office where the CT scanner
was located.
Response: We believe that allowing billing physicians
and other suppliers to comply with either the
“substantially all” professional services approach of
Alternative 1 or the “site-of-service” approach of
Alternative 2 will address our concerns while providing
sufficient flexibility for the industry. In the situations
described by the commenters, if the performing physician
furnished substantially all of his or her professional
services through the billing group, the anti-markup payment
limitation would not apply.
Comment: A commenter stated that the Alternative 2
site-of-service approach is useful in deterring program
abuse at locations other than the office of the billing
physician, and may benefit from being merged with
Alternative 1. However, the commenter asserted that we
must address the issue of the level of supervision that is
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