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Designated Health Services
Practical Law Glossary Item w-025-8407 (Approx. 3 pages)
Glossary
Designated Health Services
Under the Stark Law, a physician may not make a referral to an entity for Designated Health Services (DHS) to be paid by Medicare or Medicaid if the physician or immediate family member has a financial relationship with that entity (42 U.S.C. § 1395nn, 42 C.F.R. § 411.353(a)). The entity may not submit a claim for DHS to any individual, third party payor, or another entity if services were the result of a prohibited referral. DHS are:
- Clinical laboratory services.
- Physical and occupational therapy and speech-language pathology or services.
- Radiology and certain imaging services.
- Durable medical equipment (DME) and supplies.
- Parenteral and enteral nutrients, equipment, and supplies.
- Prosthetics, orthotics, and prosthetic devices, and supplies.
- Home health services.
- Outpatient prescription drugs.
- Inpatient and outpatient hospital services.
(42 C.F.R. § 411.351.)
For further information on DHS, see Current Procedural Terminology (CPT) and Health Care Finance Administration, Common Procedural Coding System (HCPCS) codes on the CMS website.
For more information about Stark and recent regulations, see Practice Note, Federal Physician Self-Referral Law (Stark Law): Overview.
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