42 C.F.R. 410.26 - Services and supplies incident to a physician's professional services: Conditions

Cite as42 C.F.R. 410.26
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40 practice notes
  • United States v. Marder, Case No. 1:13-cv-24503-KMM
    • United States
    • United States District Courts. 11th Circuit. United States District Courts. 11th Circuit. Southern District of Florida
    • September 23, 2016
    ...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......
  • Downtown Medical Center/Comprehensive Health Care Clinic v. Bowen, Nos. 88-2120
    • United States
    • United States Courts of Appeals. United States Court of Appeals (10th Circuit)
    • September 10, 1991
    ...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......
  • National Athletic v. U.S. Dept., Human Serv., No. 3:05-CV-1098-G.
    • United States
    • United States District Courts. 5th Circuit. United States District Courts. 5th Circuit. Northern District of Texas
    • August 25, 2005
    ...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......
  • U.S. ex rel. Lockyer v. Hawaii Pacific Health, Civ. No. 04-00596 ACK-LEK.
    • United States
    • United States District Courts. 9th Circuit. United States District Court (Hawaii)
    • April 17, 2007
    ...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
  • Downtown Medical Center/Comprehensive Health Care Clinic v. Bowen, Nos. 88-2120
    • United States
    • United States Courts of Appeals. United States Court of Appeals (10th Circuit)
    • September 10, 1991
    ...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......
  • National Athletic v. U.S. Dept., Human Serv., No. 3:05-CV-1098-G.
    • United States
    • United States District Courts. 5th Circuit. United States District Courts. 5th Circuit. Northern District of Texas
    • August 25, 2005
    ...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......
  • United States v. Marder, Case No. 1:13-cv-24503-KMM
    • United States
    • United States District Courts. 11th Circuit. United States District Courts. 11th Circuit. Southern District of Florida
    • September 23, 2016
    ...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......
  • U.S. ex rel. Lockyer v. Hawaii Pacific Health, Civ. No. 04-00596 ACK-LEK.
    • United States
    • United States District Courts. 9th Circuit. United States District Court (Hawaii)
    • April 17, 2007
    ...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
  • "Incident To" Personnel and Credentials: CMS's New Teeth to Address an Old Problem
    • United States
    • JD Supra United States
    • January 24, 2014
    ...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 ......
  • Clinics address Stark, fee-splitting and anti-kickback legal issues
    • United States
    • LexBlog United States
    • July 26, 2010
    ...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,......
  • Medicare Payment Rules Changed to Allow Broad Use of Remote Communications Technology
    • United States
    • JD Supra United States
    • April 8, 2020
    ...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......
  • CMS Addresses Current Position on Supervision and Practitioner Qualifications Under ‘Incident-To’ Billing Rules
    • United States
    • JD Supra United States
    • July 21, 2015
    ...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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