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    Comparison Chart of Anti-Kickback Safe Harbors and Stark Exceptions -- Nonmonetary Compensation

    Non-Monetary Compensation – Current as of March 2021

    Stark exception to the referral prohibition related to compensation arrangements for non-monetary compensation 42 CFR 411.357(k)

    [No comparable safe harbor]

    Items or services (not including cash or cash equivalents) that do not exceed an aggregate of $429 per calendar year (as adjusted annually).


    The compensation is not determined in any manner that takes into account the volume or value of referrals or other business generated by the referring physician.


    The compensation may not be solicited by the physician or the physician's practice (including employees and staff members).


    The annual aggregate nonmonetary compensation limit is adjusted each calendar year to the nearest whole dollar by the increase in the Consumer Price Index--Urban All Items for the 12-month period ending the preceding September 30. CMS displays after September 30 each year both the increase in the CPI-U for the 12-month period and the new nonmonetary compensation limit on the physician self-referral website


    Where an entity has inadvertently provided nonmonetary compensation to a physician in excess of the limit , such compensation is deemed to be within the limit if-- (i) The value of the excess nonmonetary compensation is no more than 50 percent of the limit; and (ii) The physician returns to the entity the excess nonmonetary compensation (or an amount equal to the value of the excess nonmonetary compensation) by the end of the calendar year in which the excess nonmonetary compensation was received or within 180 consecutive calendar days following the date the excess nonmonetary compensation was received by the physician, whichever is earlier. This repayment option may be used by an entity only once every 3 years with respect to the same referring physician.


    In addition to nonmonetary compensation up to the annual limit, an entity that has a formal medical staff may provide one local medical staff appreciation event per year for the entire medical staff. Any gifts or gratuities provided in connection with the medical staff appreciation event are subject to the non-monetary compensation limit.