C.F.R. » Title 42 » CHAPTER IV—CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES › SUBCHAPTER B—MEDICARE PROGRAM › PART 415—SERVICES FURNISHED BY PHYSICIANS IN PROVIDERS, SUPERVISING PHYSICIANS IN TEACHING SETTINGS, AND RESIDENTS IN CERTAIN SETTINGS › Subpart D—Physician Services in Teaching Settings

42 C.F.R. § 415.152

Definitions

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As used in this subpart—

Approved graduate medical education (GME) program means one of the following:

(1) A residency program approved by the Accreditation Council for Graduate Medical Education, by the American Osteopathic Association, by the Commission on Dental Accreditation of the American Dental Association, or by the Council on Podiatric Medical Education of the American Podiatric Medical Association, or other organization determined by the Secretary, provided that the applicable organization does not use accreditation criteria that promote or encourage discrimination on the basis of race, color, national origin, sex, age, disability, or religion, including the use of those characteristics or intentional proxies for those characteristics as a selection criterion for employment, program participation, resource allocation, or similar activities, opportunities, or benefits.

(2) A program otherwise recognized as an “approved medical residency program” under § 413.75(b) of this chapter.

Direct medical and surgical services means services to individual beneficiaries that are either personally furnished by a physician or furnished by a resident under the supervision of a physician in a teaching hospital making the cost election described in §§ 415.160 through 415.162.

Nonprovider setting means a setting other than a hospital, skilled nursing facility, home health agency, or comprehensive outpatient rehabilitation facility in which residents furnish services. These include, but are not limited to, family practice or multispecialty clinics and physician offices.

Resident means one of the following:

(1) An individual who participates in an approved GME program, including programs in osteopathy, dentistry, and podiatry.

(2) A physician who is not in an approved GME program, but who is authorized to practice only in a hospital, for example, individuals with temporary or restricted licenses, or unlicensed graduates of foreign medical schools. For purposes of this subpart, the term resident is synonymous with the terms intern and fellow.

Teaching hospital means a hospital engaged in an approved GME residency program in medicine, osteopathy, dentistry, or podiatry.

Teaching physician means a physician (other than another resident) who involves residents in the care of his or her patients.

Teaching setting means any provider, hospital-based provider, or nonprovider settings in which Medicare payment for the services of residents is made under the direct GME payment provisions of §§ 413.75 through 413.83, or on a reasonable-cost basis under the provisions of § 409.26 or § 409.40(f) for resident services furnished in skilled nursing facilities or home health agencies, respectively.

[60 FR 63178, Dec. 8, 1995, as amended at 61 FR 59554, Nov. 22, 1996; 63 FR 26359, May 12, 1998; 70 FR 47490, Aug. 12, 2005; 74 FR 44001, Aug. 27, 2009; 75 FR 50418, Aug. 16, 2010; 90 FR 54084, Nov. 25, 2025]
Notes of Decisions
Cited in 5 cases, 2002–2013 · leading case: United States Ex Rel. Smith v. Yale University
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United States Ex Rel. Smith v. Yale University (2006) ctd “” 42 C.F.R. § 415.152 . This broad definition of teaching physician seems to include, and thus permit billing *93 by, outside clinical attending physicians.”
Goldberg v. Rush University Medical Center (2013) ilnd “” See 42 C.F.R. § 415.152 . . The Complaint fails to specify the subsections of the Act upon which Relators' claims are based.”
US Ex Rel. Schuhardt v. Washington University (2002) moed “MCM § 15016; see also 42 C.F.R. § 415.152 (2001). [2] 20 C.F.R.”
Rhode Island Hospital v. Leavitt (2007) rid “105 (g)(1)© (1996); 42 C.F.R. § 415.152 (1996). In seeking its IME adjustment for 1996, RIH included in its FTE calculation time spent by residents in the research component of its approved residency programs.”
Goldberg v. RUSH UNIVERSITY MEDICAL CENTER (2010) ilnd · cites it 2× “See 42 C.F.R. § 415.152 . In this opinion, any doctor or surgeon referenced is also an "attending physician.”
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