42 C.F.R. 410.26 - Services and supplies incident to a physician's professional services: Conditions
| Cite as | 42 C.F.R. 410.26 |
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40 practice notes
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United States v. Marder, Case No. 1:13-cv-24503-KMM
...by other employees of the physician "incident to"9 the professional services personally rendered by the physician. 42 C.F.R. § 410.26(b)(5). Generally, Medicare covers 80 percent of the reasonable cost of medical services. See 42 U.S.C. § 1395l(a)(1). Accordingly, the patient is n......
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Downtown Medical Center/Comprehensive Health Care Clinic v. Bowen, Nos. 88-2120
...professional service. And, on this point, the relevant regulations parrot the general language of the statute. 42 C.F.R. §§ 410.10 and 410.26. However, the Medicare Carrier's Manual (MCM) elaborates on the content of this language. MCM § 2050.1 states that services and supplies are "in......
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National Athletic v. U.S. Dept., Human Serv., No. 3:05-CV-1098-G.
...by an occupational or physical therapist who meets the qualifications provided by 42 C.F.R. § 484.4. Id. at 66,421-66,422 (revising 42 C.F.R. §§ 410.26(c)(2), 410.59(a)(3)(iii), 410.60(a)(3)(iii)) (the "New Rules"). The New Rules § 410.26 Services and supplies incident to a physic......
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U.S. ex rel. Lockyer v. Hawaii Pacific Health, Civ. No. 04-00596 ACK-LEK.
...part, "Medicare Part B pays for services and supplies incident to the service of a physician (or other practitioner)." 42 C.F.R. § 410.26(b). The "incident to" rules further provide, "Services and supplies must be furnished under the direct supervision of the physic......
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18 cases
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Downtown Medical Center/Comprehensive Health Care Clinic v. Bowen, Nos. 88-2120
...professional service. And, on this point, the relevant regulations parrot the general language of the statute. 42 C.F.R. §§ 410.10 and 410.26. However, the Medicare Carrier's Manual (MCM) elaborates on the content of this language. MCM § 2050.1 states that services and supplies are "inciden......
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National Athletic v. U.S. Dept., Human Serv., No. 3:05-CV-1098-G.
...by an occupational or physical therapist who meets the qualifications provided by 42 C.F.R. § 484.4. Id. at 66,421-66,422 (revising 42 C.F.R. §§ 410.26(c)(2), 410.59(a)(3)(iii), 410.60(a)(3)(iii)) (the "New Rules"). The New Rules § 410.26 Services and supplies incident to a physician's prof......
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United States v. Marder, Case No. 1:13-cv-24503-KMM
...furnished by other employees of the physician "incident to"9 the professional services personally rendered by the physician. 42 C.F.R. § 410.26(b)(5). Generally, Medicare covers 80 percent of the reasonable cost of medical services. See 42 U.S.C. § 1395l(a)(1). Accordingly, the patient is n......
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U.S. ex rel. Lockyer v. Hawaii Pacific Health, Civ. No. 04-00596 ACK-LEK.
...in relevant part, "Medicare Part B pays for services and supplies incident to the service of a physician (or other practitioner)." 42 C.F.R. § 410.26(b). The "incident to" rules further provide, "Services and supplies must be furnished under the direct supervision of the physician (or other......
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14 firm's commentaries
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"Incident To" Personnel and Credentials: CMS's New Teeth to Address an Old Problem
...nature – that are furnished “incident to a physicians’ services.” Implementing these provisions, the Medicare regulations at 42 C.F.R. §§ 410.26 and 410.27 authorize payment for services furnished by auxiliary personnel under the supervision of physicians in the office, clinic and hospital ......
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Clinics address Stark, fee-splitting and anti-kickback legal issues
...to 42 CFR s. 411.351, “incident to” services means those services that meet the requirements of section 1861(s)(2)(A) of the Act, 42 CFR §410.26, and section 2050 of the Medicare Carriers (CMS Pub. 14–3), Part 3—Claims Process, as amended or replaced from time to time. [2] Physical therapy,......
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Medicare Payment Rules Changed to Allow Broad Use of Remote Communications Technology
...paid under the Medicare physician fee schedules, such as services performed incident to a physician’s professional service (see 42 C.F.R. § 410.26), must be provided under the direct supervision of the billing physician or nonphysician practitioner, meaning that the physician or nonphysicia......
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CMS Addresses Current Position on Supervision and Practitioner Qualifications Under ‘Incident-To’ Billing Rules
...services. In general, incident-to services must be furnished under the direct supervision of a practitioner and current regulations at 42 CFR § 410.26(b)(5) state that “[t]he [practitioner] supervising the auxiliary personnel need not be the same [practitioner] upon whose professional servi......
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8 provisions
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Medicare Program; Revisions to Payment Policies Under the Physician Fee Schedule and Other Revisions to Part B for CY 2017; Medicare Advantage Bid Pricing Data Release; Medicare Advantage and Part D Medical Loss Ratio Data Release; Medicare Advantage Provider Network Requirements; Expansion of Medicare Diabetes Prevention Program Model; Medicare Shared Savings Program Requirements
...location that is remote from the billing practitioner or remote from the beneficiary, subject to incident to rules and regulations in 42 CFR 410.26, if he or she has a qualifying relationship with the rest of the care team including the beneficiary, and is available to provide services We w......
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Medicare Program: Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems and Quality Reporting Programs; Organ Procurement Organization Reporting and Communication; Transplant Outcome Measures and Documentation Requirements; Electronic Health Record (EHR) Incentive Programs; Payment to Nonexcepted Off-Campus Provider-Based Department of a Hospital; Hospital Value-Based Purchasing (VBP) Program; Establishment of Payment Rates Under the Medicare Physician Fee Schedule for Nonexcepted Items and Services Furnished by an Off-Campus Provider-Based Department of a Hospital
...for ``incident to'' services furnished in a nonexcepted off-campus PBD would run counter to CMS' ``incident to'' regulations at 42 CFR 410.26 (b)(1), which state that services and supplies must be furnished in a noninstitutional setting to noninstitutional patients. The commenters suggested......
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Medicare:
Physicians referrals to health care entities with which they have financial relationships (Phase II),
...or grandchild. ``Incident to'' services means those services that meet the requirements of section 1861(s)(2)(A) of the Act, 42 CFR Sec. 410.26, and section 2050 of the Medicare Carriers (CMS Pub. 14-3), Part 3-- Claims Process, as amended or replaced from time to Inpatient hospital service......
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Part III
...or grandchild. ``Incident to'' services means those services that meet the requirements of section 1861(s)(2)(A) of the Act, 42 CFR Sec. 410.26, and section 2050 of the Medicare Carriers (CMS Pub. 14-3), Part 3-- Claims Process, as amended or replaced from time to Inpatient hospital service......
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