§ 6503 - Exceptions - Vermont Statutes

§ 6503. Exceptions

The provisions of section 6502 of this title shall not apply and the physician may balance bill a Medicare beneficiary if:

(1) During the calendar year prior to treatment, the Medicare beneficiary (or his or her spouse with whom he or she lived at any time during that year):

(A) received Social Security benefits or railroad retirement benefits (Tier I treated as Social Security) which were subject to federal income taxation; or

(B) did not receive Social Security benefits or railroad retirement benefits (Tier I treated as Social Security) but, had such benefits been received, they would have been subject to federal income taxation.

(2) The Medicare beneficiary refuses to sign the statement authorized by section 6504 of this title; or

(3) The service for which the beneficiary is to be billed is either an office or home visit. Office or home visits are listed as procedure codes 90000 through 90170 in the Physicians' Current Procedural Terminology, Fourth Edition (1986) published by the American Medical Association, as amended annually. Office or home visit codes for dentists, podiatrists, optometrists and chiropractors shall be the same (or equivalent) procedure codes used for doctors of medicine or osteopathy. (Added 1987, No. 51, § 1.)