CMS Pub. 100-02, ch. 6, § 10

Participating Hospitals

(Rev. 182, Issued: 03-21-14, Effective: 10-01-13, Implementation: 04-21-14)

Payment may be made under Part B for physician services and for the nonphysician

medical and other health services as provided in this section when furnished by a

participating hospital (either directly or under arrangements) to an inpatient of the

hospital, but only if payment for these services cannot be made under Part A. This policy

applies to all hospitals and critical access hospitals (CAHs) participating in Medicare,

including those paid under a prospective payment system or alternative payment

methodology such as State cost control systems, and to emergency hospital services

furnished by nonparticipating hospitals. In this section, the term “hospital” includes all

hospitals and CAHs, regardless of payment methodology, unless otherwise specified.

For services to be covered under Part A or Part B, a hospital must furnish nonphysician

services to its inpatients directly or under arrangements (see chapter 16, §170 of this

manual, “Inpatient Hospital or SNF Services Not Delivered Directly or Under

Arrangement by the Provider”). A nonphysician service is one which does not meet the

criteria defining physicians’ services specifically provided for in regulation at 42 CFR

415.102. Services "incident to" physicians’ services (except for the services of nurse

anesthetists employed by anesthesiologists) are nonphysician services for purposes of this

provision.