A. General coverage of service
Physicians' services mean the professional services performed by a physician or physicians for a patient including diagnosis, therapy, surgery, and consultation. The services must be rendered by the physician. A service may be considered to be a physician's service where the physician either examines the patient in person or is able to visualize some aspect of the patient's condition without the interposition of a third person's judgment. Direct visualization is possible by means of X-rays, electrocardiogram and electroencephalogram tapes, tissue samples, etc. Thus, for example, the interpretation by a physician of an actual electrocardiogram or electroencephalogram reading that has been transmitted via telephone (i.e., electronically rather than by means of a verbal description) is a covered service.
Professional services of the physician are covered if provided within the United States, and may be performed in a home, office, institution, or at the scene of an accident. A patient's home is anywhere the patient makes the patient's residence, e.g., a home for the aged, a nursing home, a relative's home.
Where inpatient services in a foreign hospital are covered, payment may also be made for (1) physicians' services rendered to the beneficiary while the beneficiary is an inpatient, and (2) physician's services rendered to the beneficiary outside the hospital on the day of the beneficiary's admission as an inpatient, provided the services were for the same condition for which the beneficiary was hospitalized. This provision became effective for services rendered on and after 1/1/73.
The definition of “physician,” for purposes of coverage of services furnished outside the United States, is expanded to include a foreign practitioner of one of the practices described in HI 00401.295 provided the practitioner is legally licensed to practice in the country in which the services were rendered. ( For coverage of ambulance services in connection with a covered foreign hospital stay, see HI 00610.250 .)