42 C.F.R. § 414.50 Physician billing for purchased diagnostic tests.
Title 42 - Public Health
(a) General rule. For services covered under section 1861(s)(3) of the Act and paid for under this part 414 subpart A, if a physician bills for a diagnostic test performed by an outside supplier, the payment to the physician less the applicable deductibles and coinsurance may not exceed the lowest of the following amounts: (1) The supplier's net charge to the physician. (2) The physician's actual charge. (3) The fee schedule amount for the test that would be allowed if the supplier billed directly. (b) Restriction on payment. The physician must identify the supplier and indicate the supplier's net charge for the test. If the physician fails to provide this information, CMS makes no payment to the physician and the physician may not bill the beneficiary. (1) Physicians who accept Medicare assignment may bill beneficiaries for only the applicable deductibles and coinsurance. (2) Physicians who do not accept Medicare assignment may not bill the beneficiary more than the payment amount described in paragraph (a) of this section. [56 FR 59624, Nov. 25, 1991; 57 FR 42492, Sept. 15, 1992, as amended at 63 FR 34328, June 24, 1998]
Title 42: Public Health
PART 414—PAYMENT FOR PART B MEDICAL AND OTHER HEALTH SERVICES
Subpart B—Physicians and Other Practitioners
§ 414.50 Physician billing for purchased diagnostic tests.
