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Physicians who work at teaching hospitals often involve medical students and residents in the care of their patients.

Physicians who work with medical students and residents are referred to as teaching physicians or teaching surgeons.

Medicare has developed specific rules for payment of physician services under the Medicare Physician Fee Schedule (MPFS) in this setting.

For Medicare billing purposes a teaching hospital is defined as any hospital that has an approved graduate medical education (GME) program for residents, and a teaching setting is any provider, hospital-based provider, or non-provider setting where payment for resident services is made under the direct graduate medical education payment methodology or in the case of skilled nursing facilities and home health agencies on a reasonable cost basis.

Services provided by a medical student other than review of systems and/or past family and social history must be performed in the physical presence of the physician or a resident.

Medical students are not considered to be residents or interns and Medicare does not pay for any services furnished solely by a medical student.

Critical or Key Portions of a Service For E/M services the critical or key portions of a service are those parts of the service that the teaching physician has identified as such.