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CMS-1403-FC
leases, by Physicians A, C and D. Neither the TC, nor the
PC, is subject to the anti-markup payment limitation,
because the TC and the PC were performed in the “office of
the billing physician or other supplier.” We are
permitting shared space arrangements for diagnostic testing
services that occur in the “same building” because we
believe that such arrangements can promote efficiency
without raising the same concerns for overutilization or
other abuse as arrangements that involve centralized
buildings for diagnostic testing. We reiterate however,
that we continue to have concerns with the present use of
the in-office ancillary services exception and that we may
issue a proposed rulemaking at a future date to address
those concerns.
Comment: One commenter supported the Alternative 2
“site-of-service” approach as a reasonable approach to
curbing potential overutilization. One commenter
characterized the “site-of-service” approach as more fair
than the Alternative 1 approach, even though, according to
the commenter, Alternative 1 may control perceived
overutilization while respecting the rights of pathologists
and clinicians to practice medicine in the best manner
possible. Another commenter generally was supportive of
both alternatives but favored the Alternative 2 “site-of-
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