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CMS-1403-FC
same group and in the same specialty provide substantial
physician services. The commenter asserted that, if we
mean that, in order to avoid application of the anti-markup
payment limitation, a specific individual physician must
provide the substantial physician services in that
particular location where the diagnostic services are
provided, the proposal would render unprofitable many
existing lawful arrangements for single-specialty practices
with multiple locations. The commenter further asserted
that our proposal would require physicians in multi-
practice locations to rearrange schedules so as to rotate
through practice locations where the diagnostic testing
services are provided.
One commenter contended that the focus on where the
ordering physician regularly furnishes care will affect all
physician groups where all the physician are not located in
the same building and diagnostic testing services are only
offered in a few of the group’s locations. According to
the commenter, the physician self-referral law requires a
group practice with multiple locations to function as one
group, and group practices have structured their
arrangements to meet existing governmental requirements and
to serve patients. The commenter asserted that changing
these requirements may make it impossible for some groups
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