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Jan 30

List of DHS amended by 2007 Medicare physician fee schedule

From the Medical Group Management Association (www.mgma.com):

The Centers for Medicare & Medicaid Services (CMS) published the latest update to the list of CPT/HCPCS codes defined as designated health services (DHS) subject to the Stark law. The update is part of its publication of the Medicare physician fee schedule for 2007. The new list of DHS codes features 278 additions and 60 deletions. The final list appeared in Addendum J of the Dec. 1, 2006, Federal Register, pages 70247-70251. This list can also be downloaded from the CMS Web site.

The new list of codes adds diagnostic and therapeutic nuclear medicine procedures and associated supplies as DHS subject to the Stark law’s self-referral prohibitions. These provisions, effective Jan. 1, 2007, prohibit physician referrals for nuclear medicine services when the referring physician has a financial relationship with the entity billing for the DHS.

The new provision will not prohibit most medical practices from using the Stark law’s exception for in-office ancillary services to make referrals for DHS, and to furnish nuclear medicine and other DHS.

CMS discussed the addition of nuclear medicine procedures to the list of DHS in connection with the publication of the 2006 physician fee schedule. Read the agency’s rationale for including nuclear medicine procedures as DHS on page 70283 of the Nov. 21, 2005 Federal Register.

The list does not include codes for services falling into six of the 11 DHS categories:

  • Durable medical equipment;
  • Home health services;
  • Parenteral/enteral nutrients, equipment and supplies;
  • Prosthetics, orthotics and supplies;
  • Outpatient prescription drugs; and
  • Inpatient and outpatient hospital services.
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