tci Part B Insider - 2010 Issue 21

Reader Questions: Solve Lab's PhD Interpretation Dilemma

Question: We have a PhD performing molecular diagnostics and molecular array testing in our lab. How can we bill the interpretation -- the professional component of his work? Answer: Medicare prohibits Part B professional fee payment to PhDs, instead limiting reimbursement to physicians (and certain other practitioners in some cases). Most states have laws  estricting medical practice to physicians (such as M.D.s). That means a PhD can't legally render -- or bill for -- an interpretation service that involves "the practice of medicine." Medicare has given some direction for billing when PhDs perform molecular diagnostics and...

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