Medicare Managed Care Manual (Pub. 100-16), Ch. 18b § 10
Physician Services - General
10 - Physician Services - General
(Rev. 30, 09-05-03)
Amounts paid by a Health Care Prepayment Plan (HCPP) for physicians' services are
allowable to the extent they are reasonable. Different tests of reasonableness apply,
depending upon whether the organization employs the physicians directly or pays for
physicians' services on a fee-for-service basis or some other basis.
The allowability of physician and other Part B supplier services furnished directly is
determined in accordance with §20 of this subchapter.
The allowability of physician and other Part B supplier services furnished under
arrangements is determined in accordance with the provisions of §30 of this subchapter.