Notice: This CMS-approved document has been submitted - Philips ...

CMS-1403-FC
provisions for single-specialty pathology physician groups
and independent laboratories. The commenter suggested that
such entities be defined as those in which all physicians
within the group are pathologists and for which 75 percent
of all CPT codes billed by the entity are pathology and
laboratory CPT codes. According to the commenter, such an
exception would “clarify” that dedicated pathology groups
and independent laboratories are not subject to the anti-
markup provisions for certain purchased diagnostic tests
and interpretations or the ordering of special stains to
perform better the tests ordered by outside, independent
physicians. The commenter asserted that its proposed
exception would be consistent with the physician self-
referral’s exclusion from the definition of “referral” for
services ordered by pathologists (and radiologists and
radiation oncologists) pursuant to a consultation with
another physician. According to the commenter, the
exclusion from the definition of “referral” reflects the
Congress’s recognition that services ordered by such
physicians pursuant to a consultation with another
physician do not pose the same risk of abuse that physician
self-referral generally poses. The commenter also
suggested an alternative to its proposed exception, for
independent laboratories for which at least 75 percent of
513