Spotlight

List of CPT/HCPCS Codes

The 2024 Code List is now available on the List of CPT/HCPCS Codes webpage.

CPI-U Update

The compensation limits for the nonmonetary compensation, medical staff incidental benefits, and limited remuneration to a physician exceptions have been updated for calendar year 2024 and are now available on the CPI-U Updates page.

Physician-Owned Hospital Expansion Exception Requests – Changes Effective October 1, 2023

CMS issued a final rule that is effective October 1, 2023 and modifies and clarifies the process for requesting an exception from the prohibition against facility expansion in section 1877(i)(1)(B) of the Act and reinstating certain program integrity restrictions on approved facility expansion.    

For more information, see the fact sheet on the final rule. 

Waivers of Sanctions under the Physician Self-Referral Law during Emergencies

Individual Waivers

When there is a disaster or emergency and 1135 waiver authority is available, individual waivers of sanctions under section 1877(g) of the Act may be granted upon request.  Please send your request via email to 1877CallCenter@cms.hhs.gov and include the words “Request for 1877(g) Waiver” in the subject line.  All requests should include the following minimum information:

• Name and address of requesting entity;
• Name, phone number and email address of person designated to represent the entity;
• CMS Certification Number (CCN) or Taxpayer Identification Number (TIN) of the requesting entity; and
• Nature of request.

Unless and until a waiver of sanctions under the physician self-referral law (that is, a waiver of section 1877(g) of the Social Security Act (the Act)) is granted to the requesting party(ies), such party(ies) must comply with section 1877 of the Act and the regulations at 42 C.F.R. § 411.350 et seq.

Blanket Waivers for COVID-19 Purposes (Terminated May 11, 2023)

On March 30, 2020, CMS issued blanket waivers of sanctions under the physician self-referral law for COVID-19 Purposes.  These blanket waivers provided vital flexibility for physicians and providers in the fight against COVID-19.  The waivers were effective March 1, 2020 through May 11, 2023 (unless otherwise stated in the blanket waiver document) and could be used without notifying CMS.  View the Blanket Waivers of Section 1877(g) (PDF). 

On April 21, 2020, CMS issued explanatory guidance related to the scope and application of the blanket waivers to certain financial relationships. View the Explanatory Guidance (PDF).

New Statutory Exception for Physician Wellness Programs

Section 4126 of the Consolidated Appropriations Act, 2023 (CAA 2023) amended section 1877(e) of the Social Security Act (the Act) to establish a new exception to the physician self-referral law for physician wellness programs. Provided that all the requirements of section 1877(e)(9) of the Act are satisfied, a hospital, ambulatory surgical center, community health center, rural emergency hospital, or skilled nursing facility may offer a bona fide mental health or behavioral health improvement or maintenance program to physicians who practice in the geographic area served by such entity. The exception applies to physician wellness programs offered on or after December 29, 2022 (the date of enactment of the CAA 2023)..