Author: David M. Glaser, Esq. | October 21, 2026
Once again, my computer search for a Centers for Medicare & Medicaid Services (CMS) Manual turned up massively outdated versions in the first hits. I was doing research that required analyzing the section of the Medicare Claims Processing Manual discussing the teaching physician rule.
I know exactly where the text is, so I typed “Medicare Claims Processing Manual Chapter 12” into the search bar. The opening lines of a Manual section show you when it was last revised.
One huge problem is that the CURRENT Manual won’t have today’s date; it will show when it was last revised, which could be recent, or it could be years ago. Nothing in the Manual text itself will verify that it is the most recent iteration.
My first search yielded text showing that the most recent changes had been made in 2024. That is certainly plausible, but I happen to know that the Manual has been revised more recently than that.
In fact, it was updated in May of this year. For whatever reason, the search engine felt that the “best” hit wasn’t the current version, but one that is two years old.
I decided to play around a little more and tried the search in different search engines and different browsers. The results were a bit inconsistent. One search resulted in the first hit being the Manual as it existed in 2011, with other attempts yielding the most recent Manual section. Then, later in the day, a search on an unrelated topic yielded the same problem.
This is a huge trap, and one without an easy fix, unless you go to the CMS website and pull the current Manuals, or have a good subscription service.
It’s worth talking about the situation that prompted this search. I’m involved in a teaching physician rule investigation. The government is pointing to Manual text that says, “In the case of three concurrent surgical procedures, the role of the teaching surgeon (but not an anesthesiologist) in each of the cases is classified as a supervisory service to the hospital, rather than a physician service to the individual patient, and is not payable under the physician fee schedule.” That seems simple enough. But it’s totally wrong.
The reason it’s totally wrong is that no such limitation appears in the regulation. In fact, 42 CFR § 415.172 says that in the case of surgery, the teaching physician’s presence is not required during opening and closing of the surgical field. Under the regulation, it is clear you can have one procedure opening, another closing, and the third in the critical portion, but the Manual suggests that is improper.
The manual invented a new requirement out of whole cloth. Longtime readers know that manuals are not binding. Remember that I was once in a case in which the federal government challenged my client’s reliance on the manuals by stating that you “rely on information in the manuals at your own peril.”
I look at the manuals all the time, because I want to know what’s in them. But no one should ever be refunding money off of something found in the manuals.
And if you are in a situation like I am now, where the government is seeking to recover money based on the manuals, you should fight back hard. If you find a requirement in a Manual, work your way back up to the regulations and statutes before cutting a check.
This article was originally published on RACmonitor.
