Page 31 - Medicare Benefit Policy Manual

A step-relationship and an in-law relationship continues to exist even if the marriage
upon which the relationship is based is terminated through divorce or through the death
of one of the parties. For example, if a provider treats the stepfather of the owner after
the death of the owner’s natural mother or after the owner’s stepfather and natural mother
are divorced, or if the provider treats the owner’s father-in-law or mother-in-law after the
death of their spouse, the services are considered to have been furnished to an immediate
relative, and therefore, are excluded from coverage.

C. Members of Patient’s Household

These are persons sharing a common abode with the patient as a part of a single family
unit, including those related by blood, marriage or adoption, domestic employees and
others who live together as part of a single family unit. A mere roomer or boarder is not
included.

D. Charges for Provider Services
Payment is not made under Part A or Part B for items and services furnished by providers
to immediate relatives of the owner(s) of the providers. This exclusion applies whether
the provider is a sole proprietor who has an excluded relationship to the patient, or a
partnership in which even one of the partners is related to the patient.

E. Charges for Physician and Physician-Related Services

This exclusion applies to physician services, including services of a physician who
belongs to a professional corporation, and services furnished incident to those services
(for example, by the physician’s nurse or technician) if the physician who furnished the
services or who ordered or supervised services incident to their services has an excluded
relationship to the beneficiary.

Professional corporation means a corporation that is completely owed by one or more
physicians, and is operated for the purpose of conducting the practice of medicine,
osteopathy, dentistry, podiatry, optometry, or chiropractic, or is owned by other health
care professionals as authorized by State law. Any physician or group of physicians
which is incorporated constitutes a professional corporation. (Generally, physicians who
are incorporated identify themselves by adding letters such as P.C. or P.A. after their
title.)

F. Charges for Items Furnished by Nonphysician Suppliers

This exclusion applies to charges imposed by a nonphysician supplier that is not
incorporated, whether the supplier is owned by a sole proprietor who has an excluded
relationship to the patient, or by a partnership in which even one of the partners is related.
It does not apply to charges imposed by a corporation (other than a professional
corporation), regardless of the patient’s relationship to any of the stockholders, officers,
or directors of the corporation or to the person who furnished the service.