My Policy Hub

Improving health is our policy

ACA Now

6003 - Disclosure Requirements for In-Office Ancillary Services Exception to the Prohibition on Physician Self-Referral for Certain Imaging Services

 
Implementation Status 
Statutory Text 

Summary

For purposes of the Medicare in-office ancillary exception, effective January 1, 2010, requires the referring physician to disclose to the beneficiary in writing and at the time of the referral for certain imaging services (MRI, CT, and PET), as well as other health services as designated by HHS, that the beneficiary may obtain such services from a physician other than the referring physician.  The referring physician must also provide to the beneficiary a written list of suppliers who furnish such services in the area in which such individual resides.

Implementation Status

 
Summary 
Statutory Text 

Prior to January 2013, CMS effectuated this provision via the CY 2011 Medicare PFS final rule.

2016

On July 7, CMS released its calendar year (CY) 2017 Medicare Physician Fee Schedule (MPFS) proposed rule delineating wide-ranging Medicare Part B policies that would take effect on Jan. 1, 2017. The proposed rule also would expand the Medicare Diabetes Prevention Program Model, require transparency of certain Medicare Advantage (MA) data, continue the implementation of appropriate use criteria for advanced diagnostic imaging services, and make selected refinements to the Medicare Shared Savings Program, among other policies.

Statutory Text

 
Implementation Status 
Summary 

SEC. 6003. DISCLOSURE REQUIREMENTS FOR IN-OFFICE ANCILLARY SERVICES EXCEPTION TO THE PROHIBITION ON PHYSICIAN SELF-REFERRAL FOR CERTAIN IMAGING SERVICES. (a) IN GENERAL.—Section 1877(b)(2) of the Social Security Act (42 U.S.C. 1395nn(b)(2)) is amended by adding at the end the following new sentence: ‘‘Such requirements shall, with respect to magnetic resonance imaging, computed tomography, positron emission tomography, and any other designated health services specified under subsection (h)(6)(D) that the Secretary determines appropriate, include a requirement that the referring physician inform the individual in writing at the time of the referral that the individual may obtain the services for which the individual is being referred from a person other than a person described in subparagraph (A)(i) and provide such individual with a written list of suppliers (as defined in section 1861(d)) who furnish such services in the area in which such individual resides.’’. (b) EFFECTIVE DATE.—The amendment made by this section shall apply to services furnished on or after January 1, 2010.

Contact Us

Impact Health Policy Partners 1301 K Street, NW, Suite 300W
Washington, D.C. 20005

(202) 309-0796
Contact Us