---
kind: "section"
citation: "42 C.F.R. § 415.208"
title: "42"
number: "415.208"
heading: "Services of moonlighting residents."
url: "https://uscodex.org/cfr/42/415.208"
---

# §415.208. Services of moonlighting residents.

- (a) **Definition.** For purposes of this section, the term services of moonlighting residents refers to services that licensed residents perform that are outside the scope of an approved GME program.
- (b) **Services in teaching hospitals.**
  - (1) The services of residents to inpatients of hospitals in which the residents have their approved GME program are not covered as physician services and are payable under [§§ 413.75 through 413.83](/cfr/42/413.75..413.83.md) regarding direct GME payments.
  - (2) Services of residents that are not related to their approved GME programs and are performed in an outpatient department or emergency department of a hospital in which they have their training program are covered as physician services and payable under the physician fee schedule if criteria in [paragraphs (b)(2)(i) through (iii)](#b-2-i..b-2-iii) of this section are met. The services of residents that are not related to their approved GME programs and are furnished to inpatients of a hospital in which they have their training program are covered as physician services and payable under the physician fee schedule if criteria in [paragraphs (b)(2)(i) through (iii)](#b-2-i..b-2-iii) of this section are met. The medical record must include documentation to demonstrate in each case that these criteria are satisfied.
    - (i) The services are identifiable physician services and meet the conditions for payment of physician services to beneficiaries in providers in [§ 415.102(a)](/cfr/42/415.102.md?p=a).
    - (ii) The resident is fully licensed to practice medicine, osteopathy, dentistry, or podiatry by the State in which the services are performed.
    - (iii) The services performed can be separately identified from those services that are required as part of the approved GME program.
  - (3) If the criteria specified in [paragraph (b)(2)](#b-2) of this section are met, the services of the moonlighting resident are considered to have been furnished by the individual in his or her capacity as a physician, rather than in the capacity of a resident. The carrier must review the contracts and agreements for these services to ensure compliance with the criteria specified in [paragraph (b)(2)](#b-2) of this section.
  - (4) No payment is made for services of a “teaching physician” associated with moonlighting services, and the time spent furnishing these services is not included in the teaching hospital's full-time equivalency count for the indirect GME payment ([§ 412.105](/cfr/42/412.105.md) of this chapter) and for the direct GME payment ([§§ 413.75 through 413.83](/cfr/42/413.75..413.83.md) of this chapter).
- (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)](/cfr/42/415.206.md?p=b-1).

## Notes

### Amendments

[60 FR 63178, Dec. 8, 1995, as amended at 70 FR 47490, Aug. 12, 2005; 85 FR 19289, Apr. 6, 2020; 85 FR 85037, Dec. 28, 2020]

### Authority

Authority: 42 U.S.C. 1302 and 1395hh.

### Source

Source: 60 FR 63178, Dec. 8, 1995, unless otherwise noted.

### Amendments

[60 FR 63178, Dec. 8, 1995, as amended at 70 FR 47490, Aug. 12, 2005; 85 FR 19289, Apr. 6, 2020; 85 FR 85037, Dec. 28, 2020]