Services performed by attending physicians at teaching hospitals, in collaboration with house staff in an approved GME program, generally require evidence of direct care by the attending physician in order to meet Medicare billing guidelines. CMS allows for a variance in these requirements, defined as the Primary Care Exception, and this article defines the rules and circumstances in which services may be billed.
In certain primary care centers, residents may provide E&M services in the absence of a teaching physician, when the following guidelines are met and fully documented in the associated medical records: