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Billing Insurance for Immediate Family Members

Gail Posted Tue 17th of April, 2012 18:37:40 PM

If a Doctor treats a family member can they bill their insurance?

SuperCoder Answered Tue 17th of April, 2012 19:19:51 PM

The doctor cannot bill Medicare for treating immediate family members – but what many may not realize is that the partner physician in a partnership or the PA or NP being supervised by an owner-physician may not bill Medicare for treating immediate relatives of the owner-physician. In other words – if the patient would be receiving free services if they did not have Medicare – because they’re seeing their son who is a doctor or sister who is a doctor– then you cannot bill Medicare.

130 - Charges Imposed by Immediate Relatives of the Patient or Members of the Patient’s Household(Rev. 1, 10-01-03)
A3-3161, HO-260.12, B3-2332
A. General

These are expenses that constitute charges by immediate relatives of the beneficiary or by members of their household. The intent of this exclusion is to bar Medicare payment for items and services that would ordinarily be furnished gratuitously because of the relationship of the beneficiary to the person imposing the charge. This exclusion applies to items and services rendered by providers to immediate relatives of the owner(s) of the provider. It also applies to services rendered by physicians to their immediate relatives and items furnished by suppliers to immediate relatives of the owner(s) of the supplier.

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