Designated Health Services (DHS)
Designated health services (DHS) are the specific categories of health service the Stark Law restricts a physician from referring for. They are enumerated by statute (42 U.S.C. § 1395nn(h)(6)) and defined by regulation (42 CFR § 411.351), and CMS publishes an annually updated code list identifying the CPT/HCPCS codes that are DHS. The Stark prohibition applies only when the referred service is a DHS payable by Medicare — a referral for a service outside the categories is not restricted by Stark.
Updated
Designated health services (DHS) are the defined set of service categories the physician self-referral law — the Stark Law — restricts. The law does not restrict every referral a physician makes; it restricts a referral to an entity the physician (or an immediate family member) has a financial relationship with, and only when the referral is for a DHS for which payment may be made under Medicare. The categories are what turn an ordinary referral into a Stark question.
The statute enumerates twelve categories at 42 U.S.C. § 1395nn(h)(6): clinical laboratory services; physical therapy services; occupational therapy services; outpatient speech-language pathology services; radiology and certain other imaging services (including MRI, CT, and ultrasound); 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; and inpatient and outpatient hospital services. The regulatory definition lives at 42 CFR § 411.351.
In practice
For most of the categories, CMS identifies exactly which services are DHS through an annually updated list of CPT and HCPCS codes — the DHS Code List — so whether a specific service is a DHS is a lookup against the current year's list, not a matter of opinion. A few categories, notably inpatient and outpatient hospital services and home health services, are defined by their nature rather than by a code list. Because the list changes each year, the current-year version is the one that governs.
The practical significance is that DHS is the boundary of the Stark prohibition. A physician's referral for a service that is not a DHS is outside Stark entirely — though it may still raise questions under the Anti-Kickback Statute, which is not limited to a fixed list of services. When a financial relationship exists, the first question is whether what was referred is a DHS payable by Medicare.
Commonly confused with
- Referral: A referral is the request a physician makes for an item or service; a DHS is the kind of service that request has to be for before the Stark Law applies. Stark restricts referrals specifically for designated health services, not referrals in general.
- Anti-Kickback Statute: The Stark Law is confined to referrals for this fixed list of DHS payable by Medicare. The Anti-Kickback Statute is not tied to a category list — it reaches remuneration to induce or reward the referral or purchase of any item or service payable by any federal health care program.