CMS Pub. 100-22, ch. 2, § 20.1.1

Some professionals who are included in the definition of “eligible professional” above

are eligible to participate but are not able to participate for one or more reasons. These

include: eligible professionals in certain settings in which Medicare Physician Fee

Schedule billing is processed by Medicare fiscal intermediaries (FIs)/AB Medicare

Administrative Contractors (MACs). The FI/MAC claims processing systems for the

following settings currently cannot accommodate billing at the individual eligible

professional level:

• Critical access hospitals (CAHs), method II payment, where the physician or

practitioner has reassigned his or her benefits to the CAH. In this situation, the

CAH bills the regular FI or Part A MAC for the covered professional services

furnished by the eligible professional.

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• All institutional providers that bill for outpatient therapy provided by physical and

occupational therapists and speech language pathologists (for example, hospital,

skilled nursing facility Part B, home health agency, comprehensive outpatient

rehabilitation facility, or outpatient rehabilitation facility). This does not apply to

skilled nursing facilities under Part A.