US · guidance
CMS Pub. 100-02, ch. 6, § 20.1.2
Exception to Limitation
The limitation stated in section 20.1.1 does not apply to the following services:
• Physicians’ professional services that meet the following conditions:
o The services are personally furnished for an individual beneficiary by a
physician;
o The services contribute directly to the diagnosis or treatment of an
individual beneficiary;
o The services ordinarily require performance by a physician;
o In the case of radiology or laboratory services, additional requirements in
42 CFR §415.120 and §415.130, respectively of the Code of Federal
Regulations are met.
• Physician assistant services, as defined in section 1861(s)(2)(K)(i) of the Social
Security Act (the Act);
• Nurse practitioner and clinical nurse specialist services, as defined in section
1861(s)(2)(K)(ii) of the Act;
• Qualified psychologist services, as defined in section 1861(ii) of the Act;
• Services of an anesthetist, as defined in regulations in 42 CFR 410.69;
• Services furnished to SNF residents as defined in regulations in 42 CFR
411.15(p).
History
(Rev. 82; Issued: 02-08-08; Effective: 01-01-08; Implementation: 03-10-08)
Provenance
- Source
- cms.gov
- Retrieved
- 2026-08-25
- Edition
- iom-2026-08-25
- Content hash
e30c945d90b083ce580f0f090bdab8c9b9dc309a42c36c26228dd634e22fa1f1
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