US · guidance
CMS Pub. 100-16, ch. mc86c17b, § 120
Physician Services- General
Amounts paid by a cost-based HMO/CMP for physicians’ services are allowable to the
extent they are reasonable. Different tests of reasonableness apply, depending upon
whether the organization employs the physicians directly or pays for physicians’ services
on a fee-for-service basis or some other basis.
The allowability of physician and other Part B supplier services furnished directly is
determined in accordance with §130 of this subchapter.
The allowability of physician and other Part B supplier services furnished under
arrangements is determined in accordance with the provisions of §140 of this subchapter.
History
(Rev. 4, 10-01-01)
Provenance
- Source
- cms.gov
- Retrieved
- 2026-08-25
- Edition
- iom-2026-08-25
- Content hash
670dc8d59bc6ea4e46d679c4326eedfa7a2d2674e7328a933031df1a2fbbb96e
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