Designated Health Services

Stark Law does not apply to all referrals–only to referrals for Designated Health Services (DHS). DHS are established by 42 CFR 411.351 to include:

  • Clinical laboratory services
  • Physical therapy, occupational therapy, and outpatient speech-language pathology services
  • Radiology and certain other imaging services
  • Radiation therapy services and supplies
  • Durable medical equipment and supplies
  • Parenteral and enteral nutrients, equipment, and supplies
  • Prosthetics, orthotics, and prosthetic devices and supplies
  • Home health services
  • Outpatient prescription drugs
  • Inpatient and outpatient hospital services

A little more digging is required because these services are further defined by the Stark Law. For example, “Inpatient hospital services” is defined as “those services defined in section 1861(b) of the [Social Security] Act and § 409.10(a) and (b) of this chapter and include inpatient psychiatric hospital services listed in section 1861(c) of the Act and inpatient critical access hospital services, as defined in section 1861(mm)(2) of the Act.” Certain exclusions also apply to the definition.

The definitions of other services refer you to the List of CPT/HCPCS Codes, which can be found and downloaded through the CMS website.    This list breaks down the codes for each relevant DHS category.

As you can see from this definition alone, it takes a fair amount of work to really understand exactly what the Stark Law applies to. It requires you to do a lot of digging and cross referencing. But it can be done! It’s just very tedious.