2. The request or establishment of a plan of care by a health care provider, which includes the provision of designated health services or other health care item or service. 3. The following orders, recommendations, or plans of care shall not constitute a referral by a health care provider: a. By a radiologist for diagnostic-imaging services. b. By a physician specializing in the provision of radiation therapy services for such services. c. By a medical oncologist for drugs and solutions to be prepared and administered intravenously to such oncologist’s patient, as well as for the supplies and equipment used in connection therewith to treat such patient for cancer and the complications thereof. d. By a cardiologist for cardiac catheterization services. e. By a pathologist for diagnostic clinical laboratory tests and pathological examination services, if furnished by or under the supervision of such pathologist pursuant to a consultation requested by another physician. f. By a health care provider who is the sole provider or member of a group practice for designated health services or other health care items or services that are prescribed or provided solely for such referring health care provider’s or group practice’s own patients, and that are provided or performed by or under the supervision of such referring health care provider or group practice if such supervision complies with all
accountable care organization or an entity operating under an advanced alternative payment model according to federal regulations if such entity provides diagnostic imaging services and has more than 30,000 patients enrolled per year. g. By a health care provider for services provided by an ambulatory surgical center licensed under chapter 395. h. By a urologist for lithotripsy services. i. By a dentist for dental services performed by an employee of or health care provider who is an independent contractor with the dentist or group practice of which the dentist is a member. j. By a physician for infusion therapy services to a patient of that physician or a member of that physician’s group practice. k. By a nephrologist for renal dialysis services and supplies, except laboratory services. l. By a health care provider whose principal professional practice consists of treating patients in their private residences for services to be rendered in such private residences, except for services rendered by a home health agency licensed under chapter 400. For purposes of this sub-subparagraph, the term “private residences” includes patients’ private homes, independent living centers, and assisted living facilities, but does not include skilled nursing facilities. m. By a health care provider for sleep- related testing.
(o) “Rural area” means a county with a population density of no greater than 100 persons per square mile, as defined by the United States Census. (p) “Sole provider” means one health care provider licensed under chapter 458, chapter 459, chapter 460, or chapter 461, or registered under s. 464.0123 , who maintains a separate medical office and a medical practice separate from any other health care provider and who bills for his or her services separately from the services provided by any other health care provider. A sole provider shall not share overhead expenses or professional income with any other person or group practice. outside referrals for diagnostic imaging services is required to comply with the following conditions: 1. Diagnostic imaging services must be provided exclusively by a group practice physician or by a full-time or part-time employee of the group practice or of the sole provider’s practice. 2. All equity in the group practice or sole provider’s practice accepting outside referrals for diagnostic imaging must be held by the (4) REQUIREMENTS FOR ACCEPTING OUTSIDE REFERRALS FOR DIAGNOSTIC IMAGING.— (a) A group practice or sole provider accepting
applicable Medicare payment and coverage rules for services; provided, however, a physician licensed pursuant to chapter 458, chapter 459, chapter 460, or chapter 461 or an advanced practice registered nurse registered under s. 464.0123 may refer a patient to a sole provider or group practice for diagnostic imaging services, excluding radiation therapy services, for which the sole provider or group practice billed both the technical and the professional fee for or on behalf of the patient, if the referring physician or advanced practice registered nurse registered under s. 464.0123 has no investment interest in the practice. The diagnostic imaging service referred to a group practice or sole provider must be a diagnostic imaging service normally provided within the scope of practice to the patients of the group practice or sole provider. The group practice or sole provider may accept no more than 15 percent of their patients receiving diagnostic imaging services from outside referrals, excluding radiation therapy services. However, the 15 percent limitation of this sub- subparagraph and the requirements of subparagraph (4)(a)2. do not apply to a group practice entity that owns an
physicians comprising the group practice or the sole provider’s practice, each of whom must provide at least 75 percent of his or her professional services to the group. Alternatively, the group must be incorporated under chapter 617 and must
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