Article Detail - JA DME

Original Effective Date: 12/12/2002
Revision Effective Date: 11/01/2013

According to the Medicare Carriers Manual, section 2332, Medicare will not pay for items billed by immediate relatives of beneficiaries or by immediate members of their household. This exclusion applies to items and services rendered by a related physician or supplier, even if the bill or claim is submitted by an unrelated individual or by a partnership or a professional corporation. The following degrees of relationship are included in the definition of immediate relative:

• Husband and wife;
• Natural or adoptive parent, child, and sibling;
• Stepparent, stepchild, stepbrother, and stepsister;
• Father-in-law, mother-in-law, son-in-law, daughter-in-law, brother-in-law, and sister-in-law;
• Grandparent and grandchild; and
• Spouse of grandparent and grandchild.

Note: A brother-in-law or sister-in-law relationship does not exist between a physician (or supplier) and the spouse of his wife's (her husband's) brother or sister. A father-in-law or mother-in-law relationship does not exist between a physician and his/her spouse's stepfather or stepmother.

A step-relationship and an in-law relationship continues to exist even if the marriage upon which the relationship is based terminates through divorce or through the death of one of the parties. For example, if a physician treats his stepfather after the death of his natural mother or after the stepfather and natural mother are divorced or if he treats his father-in-law or mother-in-law after the death of his wife, the services are considered to have been furnished to an immediate relative and are excluded from coverage.

Members of a patient's household are considered to be persons sharing a common abode with the patient as a part of a single family unit, including those related by blood, marriage, or adoption, domestic employees, and others who live together as part of a single family unit. A mere roomer or boarder is not included.

This exclusion applies to physician services, including services of a physician who belongs to a professional corporation and services furnished by the physician's nurse or technician if the physician who ordered or supervised services has an excluded relationship to the beneficiary. This exclusion also applies to items or services furnished by a nonphysician supplier that is not incorporated, whether the supplier is owned by a sole proprietor who is related to the patient or by a partnership in which even one of the partners is related to the patient.