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Primary Care Coding Alert

You be the Coder:

Billing for Treatment of Relatives

Published on Sun Dec 01, 2002

Test your coding knowledge. Determine how you would code this situation before looking at the box below for the answer.

Question: Recently, our 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 those 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, and 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 for her.

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