---
kind: "section"
citation: "42 C.F.R. § 1001.1701"
title: "42"
number: "1001.1701"
heading: "Billing for services of assistant at surgery during cataract operations."
url: "https://uscodex.org/cfr/42/1001.1701"
---

# §1001.1701. Billing for services of assistant at surgery during cataract operations.

- (a) **Circumstance for exclusion.** The OIG may exclude a physician whom it determines—
  - (1) Has knowingly and willfully presented or caused to be presented a claim, or billed an individual enrolled under Part B of the Medicare program (or his or her representative) for:
    - (i) Services of an assistant at surgery during a cataract operation, or
    - (ii) Charges that include a charge for an assistant at surgery during a cataract operation;
  - (2) Has not obtained prior approval for the use of such assistant from the appropriate Utilization and Quality Control Quality Improvement Organization (QIO) or Medicare carrier; and
  - (3) **Is not the sole community physician or sole source of essential specialized services in the community.**
- (b) The OIG will take into account access of beneficiaries to physicians' services for which Medicare payment may be made in determining whether to impose an exclusion.
- (c) **Length of exclusion.**
  - (1) In determining the length of an exclusion in accordance with this section, the OIG will consider the following factors—
    - (i) The number of instances for which claims were submitted or beneficiaries were billed for unapproved use of assistants during cataract operations;
    - (ii) The amount of the claims or bills presented;
    - (iii) The circumstances under which the claims or bills were made, including whether the services were medically necessary;
    - (iv) Whether approval for the use of an assistant was requested from the QIO or carrier; and
    - (v) Whether the physician has a documented history of criminal, civil, or administrative wrongdoing (the lack of any prior record is to be considered neutral).
  - (2) The period of exclusion may not exceed 5 years.

## Notes

### Amendments

[57 FR 3330, Jan. 29, 1992, as amended at 63 FR 46690, Sept. 2, 1998; 82 FR 4116, Jan. 12, 2017]

### Authority

Authority: 42 U.S.C. 1302; 1320a-7; 1320a-7b; 1395u(j); 1395u(k); 1395w-104(e)(6), 1395y(d); 1395y(e); 1395cc(b)(2)(D), (E), and (F); 1395hh; 1842(j)(1)(D)(iv), 1842(k)(1), and sec. 2455, Pub. L. 103-355, 108 Stat. 3327 (31 U.S.C. 6101 note).

### Source

Source: 57 FR 3330, Jan. 29, 1992, unless otherwise noted.

### Amendments

[57 FR 3330, Jan. 29, 1992, as amended at 63 FR 46690, Sept. 2, 1998; 82 FR 4116, Jan. 12, 2017]