Revision of the Internet Only Manual (IOM) to Remove References to “Purchased Diagnostic Test” and Replace with Language Consistent with the Anti-Markup Rule

This article, based on CR 6627, informs physicians and IDTFs that CMS will begin to change all references to “purchased diagnostic tests” in Medicare manuals to “anti-markup tests.” Until all changes are manualized, you and your billing staffs should consider any reference to a “purchased diagnostic test” to be a reference to an anti-markup test. Section 1842(n)(1) of the Social Security Act limits payment for certain diagnostic tests where the physician performing or supervising the test does not share a practice with the billing physician or other supplier. Such a test was formerly referred to as a “purchased diagnostic test”. The CY 2009 final rule (73 FR 69799, November 19, 2008) includes alternative methods for determining when the anti-markup payment limitation applies. Because this new application of the anti-markup rule is more complex than a simple contractual arrangement between two parties for a TC service, CMS is changing references to the term “purchased diagnostic test” in the IOM to reflect the new anti-markup language. CMS is not changing all of the references in the manual at one time, but will implement the changes over time beginning with this transmittal. Until all changes are manualized, contractors shall read any reference of “purchased diagnostic test” as “anti-markup test”.