Question: Resident is moonlighting in an urgent care setting. The resident is licensed but not enrolled with insurance companies. Can we follow the Teaching Physician rules for this resident and bill for services jointly performed between an attending and the resident?

Answer:  For Medicare, no, not based on my reading of the applicable statutes. “Moonlighting” specifically refers to residents operating independently, under their own license. Whether the services are rendered in a hospital/provider setting or a non-hospital/non-provider setting, federal statute expressly forbids the services of an independent “moonlighting” resident from being billed by a teaching physician.

Please see the underlined portions of the federal statute (42CFR) below:

§ 415.208 Services of moonlighting residents.

(b) Services in teaching hospitals. No payment is made for services of a “teaching physician” associated with moonlighting services…

(c) Other settings. Moonlighting services of a licensed resident in an approved GME program furnished outside the scope of that program in a hospital or other setting that does not participate in the approved GME program are payable under the physician fee schedule as set forth in § 415.206(b)(1)

§ 415.206 Services of residents in non-provider settings. [e.g., a physician’s office or urgent care]

Patient care activities of residents in approved GME programs that are furnished in non-provider settings are payable in one of the following two ways:

(a) Direct GME payments. If the conditions in § 413.78 regarding patient care activities and training of residents are met, the time residents spend in non-provider settings such as clinics, nursing facilities, and physician offices in connection with approved GME programs is included in determining the number of full-time equivalency residents in the calculation of a teaching hospital’s resident count. The teaching physician rules on carrier payments in §§ 415.170 through 415.184 apply in these teaching settings.

[above option not applicable to “moonlighting” residents]

(b) Physician fee schedule.

(1) Services furnished by a resident in a non-provider setting are covered as physician services and payable under the physician fee schedule if the following requirements are met:

(2) The resident is fully licensed to practice medicine, osteopathy, dentistry, or podiatry in the State in which the service is performed.

(3) If fee schedule payment is made for the resident’s services in a non-provider setting, payment must not be made for the services of a teaching physician.

Additional Teaching Physician Resources