[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: 42CFR415.55]



[Page 793]

 

                         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 B_Fiscal Intermediary Payments to Providers for Physician 

                                Services

 

Sec. 415.55  General payment rules.



    (a) Allowable costs. Except as specified otherwise in Sec. Sec. 

413.102 of this chapter (concerning compensation of owners), 415.60 

(concerning allocation of physician compensation costs), and 415.162 

(concerning payment for physician services furnished to beneficiaries in 

teaching hospitals), costs a provider incurs for services of physicians 

are allowable only if the following conditions are met:

    (1) The services do not meet the conditions in Sec. 415.102(a) 

regarding fee schedule payment for services of physicians to a 

beneficiary in a provider.

    (2) The services include a surgeon's supervision of services of a 

qualified anesthetist, but do not include physician availability 

services, except for reasonable availability services furnished for 

emergency rooms and the services of standby surgical team physicians.

    (3) The provider has incurred a cost for salary or other 

compensation it furnished the physician for the services.

    (4) The costs incurred by the provider for the services meet the 

requirements in Sec. 413.9 of this chapter regarding costs related to 

patient care.

    (5) The costs do not include supervision of interns and residents 

unless the provider elects reasonable cost payment as specified in Sec. 

415.160, or any other costs incurred in connection with an approved GME 

program that are payable under Sec. Sec. 413.75 through 413.83 of this 

chapter.

    (b) Allocation of allowable costs. The provider must follow the 

rules in Sec. 415.60 regarding allocation of physician compensation 

costs to determine its costs of services.

    (c) Limits on allowable costs. The intermediary must apply the 

limits on compensation set forth in Sec. 415.70 to determine its 

payments to a provider for the costs of services.



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