[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: 42CFR415.208]



[Page 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. 415.208  Services of moonlighting residents.



    (a) Definition. For purposes of this section, the term services of 

moonlighting residents refers to services that licensed residents 

perform that are outside the scope of an approved GME program.

    (b) Services in GME program hospitals. (1) The services of residents 

to inpatients of hospitals in which the residents have their approved 

GME program are not covered as physician services and are payable under 

Sec. Sec. 413.75 through 413.83 regarding direct GME payments.

    (2) Services of residents that are not related to their approved GME 

programs and are performed in an outpatient department or emergency 

department of a hospital in which they have their training program are 

covered as physician services and payable under the physician fee 

schedule if all of the following criteria are met:

    (i) The services are identifiable physician services and meet the 

conditions for payment of physician services to beneficiaries in 

providers in Sec. 415.102(a).

    (ii) The resident is fully licensed to practice medicine, 

osteopathy, dentistry, or podiatry by the State in which the services 

are performed.

    (iii) The services performed can be separately identified from those 

services that are required as part of the approved GME program.

    (3) If the criteria specified in paragraph (b)(2) of this section 

are met, the services of the moonlighting resident are considered to 

have been furnished by the individual in his or her capacity as a 

physician, rather than in the capacity of a resident. The carrier must 

review the contracts and agreements for these services to ensure 

compliance with the criteria specified in paragraph (b)(2) of this 

section.

    (4) No payment is made for services of a ``teaching physician'' 

associated with moonlighting services, and the time spent furnishing 

these services is not included in the teaching hospital's full-time 

equivalency count for the indirect GME payment (Sec. 412.105 of this 

chapter) and for the direct GME payment (Sec. Sec. 413.75 through 

413.83 of this chapter).

    (c) Other settings. Moonlighting services of a licensed resident in 

an approved GME program furnished outside the scope of that program in a 

hospital or other setting that does not participate in the approved GME 

program are payable under the physician fee schedule as set forth in 

Sec. 415.206(b)(1).



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