(Rev. 1, 10-03-03)
In certain types of medical conditions, including when a patient is withdrawn and uncommunicative due to a mental disorder or comatose, the physician may contact relatives and close associates to secure background information to assist in diagnosis and treatment planning. When a physician contacts his patientâ€™s relatives or associates for this purpose, expenses of such interviews are properly chargeable as physicianâ€™s services to the patient on whose behalf the information was secured. If the beneficiary is not an inpatient of a hospital, Part B reimbursement for such an interview is subject to the special limitation on payments for physiciansâ€™ services in connection with mental, psychoneurotic, and personality disorders. (This particular scenario doesn't apply)
A physician may also have contacts with a patientâ€™s family and associates for purposes other than securing background information. In some cases, the physician will provide counseling to members of the household. Family counseling services are covered only where the primary purpose of such counseling is the treatment of the patientâ€™s condition.
For example, two situations where family counseling services would be appropriate are as follows: (1) where there is a need to observe the patientâ€™s interaction with family members; and/or (2) where there is a need to assess the capability of and assist the family members in aiding in the management of the patient. Counseling principally concerned with the effects of the patientâ€™s condition on the individual being interviewed would not be reimbursable as part of the physicianâ€™s personal services to the patient. While to a limited degree, the counseling described in the second situation may be used to modify the behavior of the family members, such services nevertheless are covered because they relate primarily to the management of the patientâ€™s problems and not to the treatment of the family memberâ€™s problems.
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