Page 30 - Medicare Benefit Policy Manual

accidental injury or for the improvement of the functioning of a malformed body
member. For example, this exclusion does not apply to surgery in connection with
treatment of severe burns or repair of the face following a serious automobile accident, or
to surgery for therapeutic purposes which coincidentally also serves some cosmetic
purpose.

130 - Charges Imposed by Immediate Relatives of the Patient or
Members of the Patient’s Household
(Rev. 1, 10-01-03)
A3-3161, HO-260.12, B3-2332

A. General
These are expenses that constitute charges by immediate relatives of the beneficiary or by
members of their household. The intent of this exclusion is to bar Medicare payment for
items and services that would ordinarily be furnished gratuitously because of the
relationship of the beneficiary to the person imposing the charge. This exclusion applies
to items and services rendered by providers to immediate relatives of the owner(s) of the
provider. It also applies to services rendered by physicians to their immediate relatives
and items furnished by suppliers to immediate relatives of the owner(s) of the supplier.

B. Immediate Relative

The following degrees of relationship are included within the definition of immediate
relative.

• Husband and wife;

• Natural or adoptive parent, child, and sibling;

• Stepparent, stepchild, stepbrother, and stepsister;

• Father-in-law, mother-in-law, son-in-law, daughter-in-law, brother-in-law, and
sister-in-law;

• Grandparent and grandchild; and

• Spouse of grandparent and grandchild.

NOTE 1: A brother-in-law or sister-in-law relationship does not exist between the
physician, supplier or owner of a provider (or supplier) and the spouse of his wife’s or
her husband’s brother or sister.

NOTE 2: A father-in-law or mother-in-law relationship does not exist between a
physician or the owner of a provider and his or her spouse’s stepfather or stepmother.