US · guidance
CMS Pub. 100-16, ch. mc86c18b, § 10
Physician Services - General
Amounts paid by a Health Care Prepayment Plan (HCPP) 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 §20 of this subchapter.
The allowability of physician and other Part B supplier services furnished under
arrangements is determined in accordance with the provisions of §30 of this subchapter.
History
(Rev. 30, 09-05-03)
Provenance
- Source
- cms.gov
- Retrieved
- 2026-08-25
- Edition
- iom-2026-08-25
- Content hash
11589bb6fa3759e5a5010b7d807be1d73eddd37ca5c6722ac08e60420d1a0aa3
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