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CMS-1403-FC
group could recover only the fees it paid to the physician
for the TC and not any amounts paid directly to the
histotechnologist who furnished the TC. The commenter also
requested clarification regarding application of the rule
where a group purchases the TC directly from an outside
supplier or histotechnologist, without any physician
involvement.
Response: The commenter is correct in that the
performing supplier of the TC is the physician who
supervised the TC. Where the anti-markup payment
limitation applies, the billing physician or other supplier
may bill for the lowest of the following amounts: (1) the
performing supplier’s net charge to the billing physician
or other supplier; (2) the billing physician or other
supplier’s actual charge; or (3) the fee schedule amount
for the test that would be allowed if the performing
supplier billed directly. With respect to the commenter’s
question regarding whether a TC purchased from a supplier
“without any physician involvement,” as noted in this
section II.N.2.h., we have deleted the references to
purchased tests or interpretations from an “outside
supplier.” The anti-markup payment limitation will apply
if a TC is supervised by a physician who does not, within
the meaning of Alternative 1, share a practice with the
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