C.F.R. » Title 42 » CHAPTER IV—CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES › SUBCHAPTER B—MEDICARE PROGRAM › PART 414—PAYMENT FOR PART B MEDICAL AND OTHER HEALTH SERVICES › Subpart A—General Provisions

42 C.F.R. § 414.2

Definitions

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As used in this part, unless the context indicates otherwise—

AA stands for anesthesiologist assistant.

AHPB stands for adjusted historical payment basis.

CF stands for conversion factor.

CRNA stands for certified registered nurse anesthetist.

CY stands for calendar year.

FY stands for fiscal year.

GAF stands for geographic adjustment factor.

GPCI stands for geographic practice cost index.

HCPCS stands for CMS Common Procedure Coding System.

Health Professional Shortage Area (HPSA) means an area designated under section 332(a)(1)(A) of the Public Health Service Act as identified by the Secretary prior to the beginning of such year.

Major surgical procedure means a surgical procedure for which a 10-day or 90-day global period is used for payment under the physician fee schedule and section 1848(b) of the Act.

Physician services means the following services to the extent that they are covered by Medicare:

(1) Professional services of doctors of medicine and osteopathy (including osteopathic practitioners), doctors of optometry, doctors of podiatry, doctors of dental surgery and dental medicine, and chiropractors.

(2) Supplies and services covered “incident to” physician services (excluding drugs as specified in § 414.36).

(3) Outpatient physical and occupational therapy services if furnished by a person or an entity that is not a Medicare provider of services as defined in § 400.202 of this chapter.

(4) Diagnostic x-ray tests and other diagnostic tests (excluding diagnostic laboratory tests paid under the fee schedule established under section 1833(h) of the Act).

(5) X-ray, radium, and radioactive isotope therapy, including materials and services of technicians.

(6) Antigens, as described in section 1861(s)(2)(G) of the Act.

(7) Bone mass measurement.

RVU stands for relative value unit.

(8) Screening mammography services.

[56 FR 59624, Nov. 25, 1991, as amended at 57 FR 42492, Sept. 15, 1992; 58 FR 63686, Dec. 2, 1993; 59 FR 63463, Dec. 8, 1994; 60 FR 63177, Dec. 8, 1995; 63 FR 34328, June 24, 1998; 66 FR 55322, Nov. 1, 2001; 75 FR 73616, Nov. 29, 2010]
Notes of Decisions
Cited in 4 cases (1 in the last 5 years), 2004–2021 · leading case: White v. Jubitz Corp., 219 P.3d 566 (Or. 2009).
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White v. Jubitz Corp., 219 P.3d 566 (Or. 2009). · cites it 2× “See 42 C.F.R. § 414.2 (defining physician services).”
O'Laughlin v. Radiation Therapy Servs., P.S. C. (E.D. Ky. 2020). · cites it 2× “# 71), which directs the Court’s attention to 42 C.F.R. § 414.2 (5). federal programs regarding radiation oncology and chemotherapy services they provided.”
O'Laughlin v. Radiation Therapy Servs., P.S. C. (E.D. Ky. 2021). “The Court also rejected Relator’s attempt to rely on, as the source of the alleged supervision requirement, a “Response” from CMS during the comment period for a Final Rule concerning the Medicare Hospital Outpatient Prospective Payment System as well as the regulation found at…”
Texas Med. Ass'n Texas AFL-CLO Patient Advocates of Texas Allen J. Meril, M.D. & L. E. Richey v. Texas Workers Comp. Comm'n Richard F. Reynolds, Exec. Dir. & Texas Ass'n of Bus. (Tex. App. 2004). “1, 2001) (codified at 42 C.F.R. §§ 414.2 , .20, .26). The terms used in the formula stand for the following values: RVU is the relative value unit, which is a nationally uniform relative value assigned by the CMS to each service.”
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