Which tests are under the Anti-Markup Rule?

The Anti-Markup Rule is a provision set forth in the Medicare program aimed at preventing improper billing practices in the healthcare system. It specifically targets instances where a healthcare provider bills Medicare for services that were rendered by another provider, often as a means to mark up the price.

The correct answer identifies only the tests on the CMS list of anti-markup tests as being covered under this rule. This is significant because the Centers for Medicare & Medicaid Services (CMS) maintains a specific list of tests that adhere to the Anti-Markup Rule, ensuring that only designated services are subject to the limitations imposed by the rule. This includes certain imaging and laboratory services, which are explicitly outlined by CMS to prevent providers from unfairly inflating costs for tests they did not perform themselves.

Understanding the scope of the Anti-Markup Rule is essential for compliance with Medicare regulations. Services performed by independent providers and tests not charged under a clinical laboratory fee schedule, while they may be relevant in other contexts, do not directly link to the conditions of the Anti-Markup Rule as defined by the CMS list. Furthermore, the involvement of non-licensed physicians also does not directly pertain to the structure of the Anti-Markup Rule, as this focuses specifically on billing practices related to designated tests