Medicare Managed Care Manual (Pub. 100-16), Ch. 18b § 30.2
Payment by Physician Group on Fee-For-Service Basis
30.2- Payment by Physician Group on Fee-For-Service Basis
(Rev. 30, 09-05-03)
If the HCPP pays a physician group on other than a fee-for-service basis, and that
physician group pays its physicians on a fee-for-service basis, reasonable costs shall not
exceed reasonable charges as defined at 42 CFR 405 Subpart E. Subpart E limitations do
not apply if the physician group has effective incentives (as defined in
42 CFR 417.802 (b)(ii)(B)) to avoid unnecessary or unduly costly utilization.