Teaching Physicians - Residents and Interns / CMS Guidelines on Teaching Physicians

Why This Topic Matters

Teaching physician claims are highly documentation-sensitive and involve multiple CMS policy exceptions. Understanding the scope of the guidance helps providers and billing teams identify when teaching physician rules, resident involvement, and supervision requirements may affect claim processing and compliance.

Article Sections

1. 100 - Teaching Physician Services

   Defines key terms used throughout the guidance, including resident, student, teaching physician, teaching hospital, teaching setting, documentation, and physical presence.

2. 100.1 - Payment for Physician Services in Teaching Settings Under the MPFS

   Explains how services furnished in teaching settings are treated under the physician fee schedule and describes the categories of services addressed by the policy.

3. 100.1.1 - Evaluation and Management (E/M) Services

   Covers documentation expectations, common billing scenarios, student involvement, and the primary care exception for certain E/M services in teaching settings.

4. 100.1.2 - Surgical Procedures

   Addresses physician presence requirements for surgery, overlapping operations, minor procedures, anesthesia, endoscopy, and diagnostic test interpretation.

5. 100.1.3 - Psychiatry

   Discusses how the general teaching physician policy applies to psychiatric services and notes special observation methods for certain services.

6. 100.1.4 - Time-Based Codes

   Reviews teaching physician presence requirements for services billed by time-based code structures and identifies categories of services discussed under this policy.

7. 100.1.5 - Other Complex or High-Risk Procedures

   Summarizes the policy framework for complex or high-risk procedures that involve personal supervision by a physician.

8. 100.1.6 - Miscellaneous

   Covers additional teaching physician policy issues involving maternity services and renal dialysis services.

9. 100.1.7 - Assistants at Surgery in Teaching Hospitals

   Explains the framework for assistant-at-surgery payment in teaching hospitals, including special circumstances and team-based surgical situations.

10. 100.1.8 - Physician Billing in the Teaching Setting

    Addresses hospital and carrier billing processes for services provided in teaching settings.

11. 100.2 - Interns and Residents

    Provides general guidance on attending physician services to beneficiaries when interns and residents participate in care.