42 C.F.R. § 410.27 Outpatient hospital services and supplies incident to a physician service: Conditions.
Title 42 - Public Health
(a) Medicare Part B pays for hospital services and supplies furnished incident to a physician service to outpatients, including drugs and biologicals that cannot be self-administered, if— (1) They are furnished— (i) By or under arrangements made by a participating hospital, except in the case of an SNF resident as provided in §411.15(p) of this chapter; (ii) As an integral though incidental part of a physician's services; and (iii) In the hospital or at a location (other than an RHC or an FQHC) that CMS designates as a department of a provider under §413.65 of this chapter; and (2) In the case of partial hospitalization services, also meet the conditions of paragraph (d) of this section. (b) Drugs and biologicals are also subject to the limitations specified in §410.168. (c) Rules on emergency services furnished to outpatients by nonparticipating hospitals are specified in §410.168. (d) Medicare Part B pays for partial hospitalization services if they are— (1) Prescribed by a physician who certifies and recertifies the need for the services in accordance with subpart B of part 424 of this chapter; and (2) Furnished under a plan of treatment as required under subpart B of part 424 of this chapter. (e) Services furnished by an entity other than the hospital are subject to the limitations specified in §410.42(a). (f) Services furnished at a location (other than an RHC or an FQHC) that CMS designates as a department of a provider under §413.65 of this chapter must be under the direct supervision of a physician. “Direct supervision” means the physician must be present and on the premises of the location and immediately available to furnish assistance and direction throughout the performance of the procedure. It does not mean that the physician must be present in the room when the procedure is performed. [56 FR 8841, Mar. 1, 1991, as amended at 63 FR 26307, May 12, 1998; 65 FR 18536, Apr. 7, 2000]
Title 42: Public Health
PART 410—SUPPLEMENTARY MEDICAL INSURANCE (SMI) BENEFITS
Subpart B—Medical and Other Health Services
§ 410.27 Outpatient hospital services and supplies incident to a physician service: Conditions.
