Page 120 - Medicare Benefit Policy Manual

A separate charge for the services of a physicist is not recognized unless such services are
covered under the “incident to” provision (§60.1 of this chapter) or the services are
included as part of a technical component service billed by a freestanding radiation
therapy center. The incident to provision may also be extended to include all necessary
and appropriate services supplied by a radiation physicist assisting a radiologist when the
physicist is in the physician’s employ and working under his or her direct supervision.

100 - Surgical Dressings, Splints, Casts, and Other Devices Used for
Reductions of Fractures and Dislocations
(Rev. 1, 10-01-03)
B3-2079, A3-3110.3, HO-228.3,

Surgical dressings are limited to primary and secondary dressings required for the
treatment of a wound caused by, or treated by, a surgical procedure that has been
performed by a physician or other health care professional to the extent permissible under
State law. In addition, surgical dressings required after debridement of a wound are also
covered, irrespective of the type of debridement, as long as the debridement was
reasonable and necessary and was performed by a health care professional acting within
the scope of his/her legal authority when performing this function. Surgical dressings are
covered for as long as they are medically necessary.

Primary dressings are therapeutic or protective coverings applied directly to wounds or
lesions either on the skin or caused by an opening to the skin. Secondary dressing
materials that serve a therapeutic or protective function and that are needed to secure a
primary dressing are also covered. Items such as adhesive tape, roll gauze, bandages, and
disposable compression material are examples of secondary dressings. Elastic stockings,
support hose, foot coverings, leotards, knee supports, surgical leggings, gauntlets, and
pressure garments for the arms and hands are examples of items that are not ordinarily
covered as surgical dressings. Some items, such as transparent film, may be used as a
primary or secondary dressing.

If a physician, certified nurse midwife, physician assistant, nurse practitioner, or clinical
nurse specialist applies surgical dressings as part of a professional service that is billed to
Medicare, the surgical dressings are considered incident to the professional services of
the health care practitioner. (See §§60.1, 180, 190, 200, and 210.) When surgical
dressings are not covered incident to the services of a health care practitioner and are
obtained by the patient from a supplier (e.g., a drugstore, physician, or other health care
practitioner that qualifies as a supplier) on an order from a physician or other health care
professional authorized under State law or regulation to make such an order, the surgical
dressings are covered separately under Part B.

Splints and casts, and other devices used for reductions of fractures and dislocations are
covered under Part B of Medicare. This includes dental splints.

110 - Durable Medical Equipment - General
(Rev. 1, 10-01-03)