[Code of Federal Regulations]

[Title 42, Volume 2]

[Revised as of October 1, 2005]

From the U.S. Government Printing Office via GPO Access

[CITE: 42CFR415.206]



[Page 808-809]

 

                         TITLE 42--PUBLIC HEALTH

 

                    CHAPTER IV--CENTERS FOR MEDICARE

                          & MEDICAID SERVICES,

                        DEPARTMENT OF HEALTH AND

                             HUMAN SERVICES

 

PART 415_SERVICES FURNISHED BY PHYSICIANS IN PROVIDERS, SUPERVISING 

PHYSICIANS IN TEACHING SETTINGS, AND RESIDENTS IN CERTAIN SETTINGS

--Table of Contents

 

                     Subpart E_Services of Residents

 

Sec. 415.206  Services of residents in nonprovider settings.



    Patient care activities of residents in approved GME programs that 

are furnished in nonprovider settings are payable in one of the 

following two ways:

    (a) Direct GME payments. If the conditions in Sec. 413.78 regarding 

patient care activities and training of residents are met, the time 

residents spend in nonprovider settings such as clinics, nursing 

facilities, and physician offices in connection with approved GME 

programs is included in determining the number of full-time equivalency 

residents in the calculation of a teaching hospital's resident count. 

The teaching physician rules on carrier payments in Sec. Sec. 415.170 

through 415.184 apply in these teaching settings.



[[Page 809]]



    (b) Physician fee schedule. (1) Services furnished by a resident in 

a nonprovider setting are covered as physician services and payable 

under the physician fee schedule if the following requirements are met:

    (i) The resident is fully licensed to practice medicine, osteopathy, 

dentistry, or podiatry in the State in which the service is performed.

    (ii) The time spent in patient care activities in the nonprovider 

setting is not included in a teaching hospital's full-time equivalency 

resident count for the purpose of direct GME payments.

    (2) Payment may be made regardless of whether a resident is 

functioning within the scope of his or her GME program in the 

nonprovider setting.

    (3) If fee schedule payment is made for the resident's services in a 

nonprovider setting, payment must not be made for the services of a 

teaching physician.

    (4) The carrier must apply the physician fee schedule payment rules 

set forth in subpart A of part 414 of this chapter to payments for 

services furnished by a resident in a nonprovider setting.



[60 FR 63178, Dec. 8, 1995, as amended at 70 FR 47490, Aug. 12, 2005]