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CMS-1403-FC
reducing access to care for this already underserved
population.
Response: We do not expect the anti-markup payment
limitation would apply in the situation described by the
commenter, because, under Alternative 1 as finalized in
this final rule with comment period, the performing
cardiologist likely would share a practice with the
cardiology group billing for the PC (or would be billing
for the PC himself or herself). If the cardiologist
reassigns payment to the hospital which then bills for the
PC, the anti-markup payment limitation would not apply
because the hospital did not order the PC.
h. Definition of Outside Supplier
Comment: We proposed that the TC of a diagnostic test
is not purchased from an outside supplier if the TC is both
conducted and supervised in the office of the billing
physician or other supplier and the supervising physician
is an employee or independent contractor of the billing
physician or other supplier. (For ease of reference, we
refer to this below as the “primary proposed definition”.)
In the alternative, we proposed that: (1) if the TC is
conducted by a technician who is not an employee of the
billing supplier, the TC is considered to be purchased from
an outside supplier, regardless of where the technician
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