Page 20 - Medicare Benefit Policy Manual

B. Services Furnished by Interns and Residents Outside the Scope of an Approved
Training Program - Moonlighting

Medical and surgical services furnished by interns and residents that are not related to
their training program, and are performed outside the facility where they have their
training program, are covered as physician services where the requirements in the first
two bullets below are met. Medical and surgical services furnished by interns and
residents that are not related to their training program, and are performed in an outpatient
department or emergency room of the hospital where they have their training program,
are covered as physicians’ services where all three of the following criteria are met:

• The services are identifiable physician services, the nature of which requires
performance by a physician in person and which contribute to the diagnosis or
treatment of the patient’s condition;

• The intern or resident is fully licensed to practice medicine, osteopathy, dentistry,
or podiatry by the State in which the services are performed; and

• The services performed can be separately identified from those services that are
required as part of the training program.

When these criteria are met, the services are considered to have been furnished by the
individuals in their capacity as physicians and not in their capacity as interns and
residents.

30.4 - Optometrist’s Services
(Rev. 1, 10-01-03)
B3-2020.25

Effective April 1, 1987, a doctor of optometry is considered a physician with respect to
all services the optometrist is authorized to perform under State law or regulation. To be
covered under Medicare, the services must be medically reasonable and necessary for the
diagnosis or treatment of illness or injury, and must meet all applicable coverage
requirements. See the Medicare Benefit Policy Manual, Chapter 16, “General Exclusions
from Coverage,” for exclusions from coverage that apply to vision care services, and the
Medicare Claims Processing Manual, Chapter 12, “Physician/Practitioner Billing,” for
information dealing with payment for items and services furnished by optometrists.

A. FDA Monitored Studies of Intraocular Lenses

Special coverage rules apply to situations in which an ophthalmologist is involved in a
Food and Drug Administration (FDA) monitored study of the safety and efficacy of an
investigational Intraocular Lens (IOL). The investigation process for IOLs is unique in
that there is a core period and an adjunct period. The core study is a traditional, well-
controlled clinical investigation with full record keeping and reporting requirements. The
adjunct study is essentially an extended distribution phase for lenses in which only