Stark Personal Services Arrangements Exception (42 CFR 411.357(d))
Compensation arrangement exception for personal services with conditions parallel to but separate from the AKS personal services safe harbor.
Primary source
42 CFR 411.357(d) — eCFR →https://www.ecfr.gov/current/title-42/chapter-IV/subchapter-B/part-411/subpart-J/section-411.357#p-411.357(d)
Verified May 23, 2026 · This is the authoritative regulator URL. The summary below is a research aid; the linked source controls.
42 CFR 411.357(d)) is the Stark personal services arrangement exception. Conditions:
- Written agreement signed by the parties.
- Services covered: agreement specifies services covered by the arrangement.
- Aggregate services: agreement covers all of the services provided by the physician to the entity.
- Services do not exceed those reasonably necessary.
- Term: at least one year.
- Compensation: set in advance, does not exceed fair market value, and (except in limited circumstances) is not determined in a manner that takes into account the volume or value of referrals or other business generated between the parties.
- Lawful services: do not involve counseling or promoting an arrangement that violates federal or state law.
- Holdover: arrangements that expired after at least one year may continue on the same terms for an indefinite holdover.
Stark and AKS personal services tests overlap substantially but differ in scope: Stark applies only to physician arrangements implicating DHS referrals; AKS applies to all federal health program referral inducements regardless of practitioner type. Most prudent counsel structure personal services arrangements to satisfy both regimes simultaneously.
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Related across the archive
- RegulationStark Rental of Office Space Exception (42 CFR 411.357(a))Stark exception for rental payments for office space with conditions on lease form, term, fair market value, and exclusive use of rented space.
- RegulationStark Law Overview (42 USC 1395nn)Strict-liability prohibition on physician referrals to entities for designated health services payable by Medicare when the physician (or immediate family member) has a financial relationship with the entity, unless an exception applies.
- RegulationAKS Personal Services and Management Contracts Safe Harbor (42 CFR 1001.952(d))Safe harbor for compensation to an independent contractor for personal services, with seven conditions including written agreement, fair market value, and aggregate compensation set in advance.
- RegulationStark Group Practice Definition (42 CFR 411.352)Strict structural and operational definition of 'group practice' for purposes of the in-office ancillary services exception and physician services exception.
- RegulationStark In-Office Ancillary Services Exception (42 CFR 411.355(b))Ownership/investment and compensation exception permitting many group-practice ancillary services (lab, imaging, PT) when furnished in the same building or centralized building under defined conditions.
Last reviewed May 23, 2026 · Citation verified May 23, 2026
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