Page 87 - Medicare Benefit Policy Manual

A physician directed clinic is one where:

1. A physician (or a number of physicians) is present to perform medical (rather than
administrative) services at all times the clinic is open;

2. Each patient is under the care of a clinic physician; and

3. The nonphysician services are under medical supervision.

In highly organized clinics, particularly those that are departmentalized, direct physician
supervision may be the responsibility of several physicians as opposed to an individual
attending physician. In this situation, medical management of all services provided in the
clinic is assured. The physician ordering a particular service need not be the physician
who is supervising the service. Therefore, services performed by auxiliary personnel and
other aides are covered even though they are performed in another department of the
clinic.

Supplies provided by the clinic during the course of treatment are also covered. When
the auxiliary personnel perform services outside the clinic premises, the services are
covered only if performed under the direct supervision of a clinic physician. If the clinic
refers a patient for auxiliary services performed by personnel who are not supervised by
clinic physicians, such services are not incident to a physician’s service.

60.4 - Services Incident to a Physician’s Service to Homebound Patients
Under General Physician Supervision
(Rev. 1, 10-01-03)
B3-2051

A. When Covered

In some medically underserved areas there are only a few physicians available to provide
services over broad geographic areas or to a large patient population. The lack of
medical personnel (and, in many instances, a home health agency servicing the area)
significantly reduces the availability of certain medical services to homebound patients.
Some physicians and physician-directed clinics, therefore, call upon nurses and other
paramedical personnel to provide these services under general (rather than direct)
supervision. In some areas, such practice has tended to become the accepted method of
delivery of these services.

The Senate Finance Committee Report accompanying the 1972 Amendments to the Act
recommended that the direct supervision requirement of the “incident to” provision be
modified to provide coverage for services provided in this manner.

Accordingly, to permit coverage of certain of these services, the direct supervision
criterion in §60.2 above is not applicable to individual or intermittent services outlined in