Page 88 - Medicare Benefit Policy Manual

this section when they are performed by personnel meeting any pertinent State
requirements (e.g., a nurse, technician, or physician extender) and where the criteria
listed below also are met:

1 The patient is homebound; i.e., confined to his or her home (see §60.4.1 for the
definition of a “homebound” patient and §110.1 (D) for the definition of patient’s
“place of residence.”

2 The service is an integral part of the physician’s service to the patient (the patient
must be one the physician is treating), and is performed under general physician
supervision by employees of the physician or clinic. General supervision means
that the physician need not be physically present at the patient’s place of
residence when the service is performed; however, the service must be performed
under his or her overall supervision and control.

The physician orders the service(s) to be performed, and contact is maintained
between the nurse or other employee and the physician, e.g., the employee
contacts the physician directly if additional instructions are needed, and the
physician must retain professional responsibility for the service. All other
“incident to” requirements must be met (see §§60-60.4).

3 The services are included in the physician’s/clinic’s bill, and the physician or
clinic has incurred an expense for them (see §60.2).

4 The services of the paramedical are required for the patient’s care; that is, they are
reasonable and necessary as defined in the Medicare Benefit Policy Manual,
Chapter 16, “General Exclusions from Coverage,” §20.

5 When the service can be furnished by an HHA in the local area, it cannot be
covered when furnished by a physician/clinic to a homebound patient under this
provision, except as described in §60.4.C.

B. Covered Services

Where the requirements in §60.4.A are met, the direct supervision requirement in §60.2 is
not applicable to the following services:

1. Injections;

2. Venipuncture;

3. EKGs;

4. Therapeutic exercises;

5. Insertion and sterile irrigation of a catheter;