[Code of Federal Regulations]
[Title 42, Volume 2]
[Revised as of October 1, 2002]
From the U.S. Government Printing Office via GPO Access
[CITE: 42CFR414.39]

[Page 628-629]
 
                         TITLE 42--PUBLIC HEALTH
 
                             HUMAN SERVICES
 
PART 414--PAYMENT FOR PART B MEDICAL AND OTHER HEALTH SERVICES--Table of Contents
 
              Subpart B--Physicians and Other Practitioners
 
Sec. 414.39  Special rules for payment of care plan oversight.

    (a) General. Except as specified in paragraph (b) of this section, 
payment for care plan oversight is included in the payment for visits 
and other services under the physician fee schedule.
    (b) Exception. Separate payment is made under the following 
conditions for physician care plan oversight services furnished to 
beneficiaries who receive HHA and hospice services that are covered by 
Medicare:
    (1) The care plan oversight services require recurrent physician 
supervision of therapy involving 30 or more minutes of the physician's 
time per month.
    (2) Payment is made to only one physician per patient for services 
furnished during a calendar month period. The physician must have 
furnished a service requiring a face-to-face encounter with the patient 
at least once during

[[Page 629]]

the 6-month period before the month for which care plan oversight 
payment is first billed. The physician may not have a significant 
ownership interest in, or financial or contractual relationship with, 
the HHA in accordance with Sec. 424.22(d) of this chapter. The physician 
may not be the medical director or employee of the hospice and may not 
furnish services under an arrangement with the hospice.
    (3) If a physician furnishes care plan oversight services during a 
postoperative period, payment for care plan oversight services is made 
if the services are documented in the patient's medical record as 
unrelated to the surgery.

[59 FR 63463, Dec. 8, 1994; 60 FR 49, Jan. 3, 1995; 60 FR 36733, July 
18, 1995]