Neurology & Pain Management Coding Alert

Question: Recently, our neurology practice began treating an aunt of one of the group physicians. Can we bill Medicare for these services, or are they excluded because the patient is a member of the physician's family?

Michigan Subscriber

Answer: Medicare will not reimburse a physician for services (including incident-to services) provided to members of his or her household or members of his or her immediate family, including services provided by a group practice of which the physician is a member. According to the Medicare Carriers Manual, section 2332, Medicare defines immediate family as husband or wife, natural or adoptive parent, child or sibling, stepparents, stepchildren, stepbrothers/sisters, father- or mother-in-law, son- or daughter-in-law and brother- or sister-in-law, grandparent or grandchild, and spouses of grandparents or grandchildren. Therefore, assuming the physician's aunt is not a member of his household, she is not included in the "restricted" categories, and your practice may bill Medicare for services you provide.