CMS Issues Final Anti-Markup Rule for Diagnostic Tests


On October 30, 2008, CMS issued the final anti-markup rule for diagnostic tests, after one year of uncertainty on the scope and application of the rule.

Historically, the "anti-markup rule" applied to the technical component (TC) of diagnostic tests that were ordered and billed by a physician, but purchased from another physician. The billing physician could not mark up the purchased test, which meant that the Medicare payment could not exceed the performing physician's net charge, the billing physician's actual charge, or the fee schedule amount — whichever was lowest. The term "net charge" was not defined.

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