Defining “Family”

September 1, 2006

What are the rules for a physician who sees a member of her own family? I know immediate family members cannot be charged, but what does “immediate family” consist of?

Question: What are the rules for a physician who sees a member of her own family? I know immediate family members cannot be charged, but what does "immediate family" consist of?

Answer: According to the Medicare Carriers Manual, Section 2332, Medicare will not pay for services provided by immediate family members of Medicare beneficiaries. That exclusion applies even if your nurse or technician provides the service "incident to."

Medicare defines an immediate relative as your:

  • Spouse;



  • Natural or adoptive parent, child, or sibling;



  • Stepparent, stepchild, stepbrother, or stepsister;



  • Father-in-law, mother-in-law, son-in-law, daughter-in-law, brother-in-law, or sister-in-law;



  • Grandparent or grandchild; and



  • Spouse of your grandparent or grandchild.