Marketing in-office lab, imaging and therapy

A practice adds an X-ray room, a lab draw station or a physical therapy suite. The next step feels obvious: tell patients. A new page on the website, a sign at check-in, a line in the recall email, a note on the after-visit summary saying the test can be done down the hall today. Each of those is marketing a service that the same physicians order. That is where the federal physician self-referral law, the anti-kickback statute and state disclosure laws meet your marketing plan.

This guide is for practices of any specialty that promote their own in-house ancillary services to their own patients. For specialty detail, see our guides to imaging center marketing, cardiology practice marketing and orthopedic practice marketing. Referrals coming in from other clinicians are covered in our guide to patient and physician referrals. Office-based labs with physician investors are covered in office-based lab marketing.

This is general information, not legal advice. Sources cited were checked on October 31, 2026: 42 USC 1395nn (the physician self-referral law, also called the Stark law); 42 CFR 411.351, 411.354 and 411.355; 42 USC 1395a; 42 USC 1320a-7b(b) (the anti-kickback statute); 42 USC 1320a-7a(a)(5); 45 CFR 164.501; 15 USC 45; Florida Statutes 456.052 and 456.053; and New York Public Health Law 238-d. We found no federal rule or agency guidance written for marketing in-office ancillary services as such. State rules differ, and the Stark exception has conditions on ownership, location, supervision and billing that a marketing review cannot confirm, so have a health care attorney review the arrangement and your materials.

The short version

If a physician has a financial relationship with an entity, the physician may not refer Medicare patients to it for designated health services, and the entity may not bill for them, unless an exception applies (42 USC 1395nn(a)(1)). The practice a physician owns or works for can be such an entity.
Designated health services include clinical laboratory, physical and occupational therapy, radiology and imaging, durable medical equipment, prosthetics and orthotics, and outpatient prescription drugs (42 USC 1395nn(h)(6)).
The in-office ancillary services exception sets conditions on who furnishes the service, where and how it is billed (42 CFR 411.355(b)). Marketing cannot fix an arrangement that misses them.
For MRI, CT and PET under this exception, the referring physician must give the patient written notice at the time of the referral that they may get the service elsewhere, with a list of other suppliers within 25 miles (42 CFR 411.355(b)(7)).
Medicare patients may obtain services from any qualified participating provider who agrees to furnish them (42 USC 1395a(a)). Your materials should not suggest otherwise.
Florida and New York have their own disclosure laws for referrals where the provider has a financial interest (Fla. Stat. 456.052; N.Y. Pub. Health Law 238-d).

Why marketing your own services is a referral question

When a physician orders a lab test, an X-ray or a course of physical therapy and the practice furnishes it, that order is a referral to an entity the physician has a financial relationship with. 42 USC 1395nn(a)(1) says that in that case the physician may not make the referral for designated health services payable by Medicare, and the entity may not bill for them, unless an exception applies. If the law is broken, no Medicare payment may be made for the service, and amounts collected must be refunded to the person who paid (42 USC 1395nn(g)(1), (g)(2)).

The list of designated health services is in 42 USC 1395nn(h)(6): clinical laboratory services; physical therapy; occupational therapy; radiology services, including MRI, CT and ultrasound; radiation therapy; durable medical equipment and supplies; parenteral and enteral nutrients; prosthetics, orthotics and supplies; home health services; outpatient prescription drugs; inpatient and outpatient hospital services; and outpatient speech-language pathology. 42 CFR 411.351 defines these categories more precisely, including by a published code list for lab and imaging, so check each service you plan to promote against the current list.

Marketing does not create the referral, but it shows how the practice thinks about it. A page that says patients must use your lab, a script that steers patients away from outside options or a bonus tied to in-house test volume can each become evidence about the arrangement. The goal is materials that inform patients about a convenient option while the exception, not the marketing, carries the legal weight.

What the in-office ancillary services exception asks for

The statute sets out the exception in 42 USC 1395nn(b)(2), and the regulation spells it out in 42 CFR 411.355(b). In plain terms, it looks at three things.

Who furnishes the service. The referring physician, a physician in the same group practice, or an individual supervised by one of them, with supervision that meets the other Medicare payment and coverage rules for that service (42 CFR 411.355(b)(1)).
Where it is furnished. In the same building as the practice, under one of three tests based on office hours and physician hours, or in a centralized building the group practice uses (42 CFR 411.355(b)(2)). The same building means a single street address assigned by the Postal Service, not counting parking lots, lawns or mobile vans (42 CFR 411.351). A centralized building must be owned or leased full time by the group and used only by it (42 CFR 411.351).
How it is billed. By the performing or supervising physician, the group practice under its billing number, an entity wholly owned by the physician or group, or a billing company acting as their agent (42 CFR 411.355(b)(3)).

Durable medical equipment is narrow under this exception. It covers canes, crutches, walkers, folding manual wheelchairs and blood glucose monitors, under further conditions, such as the item being one the patient needs to walk or to leave the office (42 CFR 411.355(b)(4)). A page that promotes a full range of in-house equipment for Medicare patients may describe items outside the exception.

For marketing, these conditions set the boundaries of what you can honestly say. If therapy is delivered at a second address that is not a centralized building of the group, the arrangement needs its own legal review before any page calls it part of the practice. If a service is furnished by an outside company in your space, say so and have counsel review the arrangement, rather than presenting it as your in-house service.

The MRI, CT and PET notice

The statute requires the Secretary to include, for MRI, CT, PET and other services the Secretary selects, a rule that the referring physician tell the patient in writing at the time of the referral that they may obtain the service from someone else, with a written list of suppliers in the area where the patient lives (42 USC 1395nn(b)(2)).

The regulation sets the details (42 CFR 411.355(b)(7)):

The notice is in writing and given at the time of the referral.
It lists at least 5 other suppliers of the service within a 25-mile radius of the referring physician’s office location at that time.
For each supplier, it gives at least the name, address and telephone number.
It should be written so that all patients can reasonably understand it.
If there are fewer than 5 other suppliers within 25 miles, the physician lists all of them. If there are none, no list is required.

Your website, signs and emails do not replace this notice. They also should not undercut it. A page that says “get your MRI here, no need to go anywhere else” sits badly next to a notice that tells the patient they can go elsewhere. No federal rule we found requires your marketing to repeat the notice. We recommend wording that matches it: in-house imaging is offered for convenience, and patients may choose another supplier.

Patient choice in your wording

For Medicare patients, 42 USC 1395a(a) says an individual entitled to Medicare may obtain health services from any institution, agency or person qualified to participate who undertakes to provide them. Separately, where a physician’s pay under employment or a personal service arrangement is conditioned on referrals to a particular provider, the requirement must not apply if the patient prefers a different provider, the patient’s insurer decides, or the referral is not in the patient’s best medical interests in the physician’s judgment (42 CFR 411.354(d)(4)(iv)(B)).

No federal rule we found sets marketing wording for patient choice. We recommend:

Present in-house services as an option: “You can have your blood drawn here before you leave, or at any lab your insurance covers.”
Do not say or imply that a patient must use your lab, imaging or therapy to stay a patient or to get results reviewed.
Train front desk and clinical staff to answer “Can I go somewhere else?” with a plain yes and help with the order.
Keep insurance claims accurate: only say a service is covered or in network if you have checked it for that plan.

Florida and New York disclosure laws

State self-referral and disclosure laws can reach beyond Medicare and can apply to all payers. Two examples we checked:

Florida. Florida’s Patient Self-Referral Act generally bars a provider from referring a patient for designated health services, defined there as clinical laboratory, physical therapy, comprehensive rehabilitative, diagnostic imaging and radiation therapy services, to an entity in which the provider is an investor (Fla. Stat. 456.053(3)(c), (5)(a)). Orders for services provided solely for the group practice’s own patients and performed by or under the supervision of the group are excluded from the definition of referral, with detailed conditions (Fla. Stat. 456.053(3)(n)3.f.). A separate section says that before referring a patient to an entity in which the provider is an investor, the provider must give the patient a written disclosure of the investment interest, the patient’s right to choose where to get the service, and at least two alternative sources, and must post a copy of the disclosure forms in a conspicuous public place in the office (Fla. Stat. 456.052). Ask counsel whether your setup triggers that section.

New York. New York requires a practitioner who refers a patient to a provider in which the practitioner or an immediate family member has an ownership or investment interest, or certain compensation arrangements, to disclose that relationship and the patient’s right to use a specifically identified alternative provider if one is reasonably available (N.Y. Pub. Health Law 238-d(1), (2)). The section has an exception tied to referrals that the state’s self-referral law in section 238-a would not prohibit (238-d(3)).

Other states have their own laws, and licensing boards can add rules. Ask counsel which apply in each state where you practice.

Offers, discounts and free extras

Promoting a service is one thing. Paying patients or referral sources to use it is another. The anti-kickback statute makes it a felony to knowingly and willfully offer or pay remuneration to induce someone to refer a patient for, or to order or recommend, an item or service paid by a federal health care program (42 USC 1320a-7b(b)(2)). A separate civil law covers remuneration to Medicare or Medicaid patients that the giver knows or should know is likely to influence the patient to choose a particular provider for covered items or services (42 USC 1320a-7a(a)(5)).

For in-office services, that means caution with:

Free or discounted lab panels or scans offered to Medicare or Medicaid patients to bring them to your in-house service.
Routine waivers of copays for in-house tests.
Gift cards or prizes tied to completing in-house therapy visits.
Perks for outside clinicians who send patients to your imaging or lab.

Our guides to free consultation offers and gifts and meals for referring physicians cover those rules in depth.

Telling existing patients: HIPAA and accuracy

Under HIPAA, a communication that describes a health-related product or service provided by the covered entity making the communication is excluded from the definition of marketing, unless the covered entity receives financial remuneration for making it (45 CFR 164.501). So a note to your own patients that your office now offers in-house physical therapy is generally not marketing that needs a separate authorization. The rest of HIPAA, and federal and state rules for email and text messages, still apply. See our guides to HIPAA marketing rules and healthcare email marketing.

Claims about the service fall under Section 5 of the FTC Act, which makes deceptive acts or practices in or affecting commerce unlawful (15 USC 45(a)(1)). No rule we found sets specific wording. We recommend:

Say “results in minutes” or “same-day results” only for tests where that is true on a normal day, and name the tests.
Describe equipment by what it does for the patient, and only if your clinicians confirm it.
List the services you actually furnish in-house, and keep the page current when a service moves out or stops.
Say who performs the service, by license type, not with vague titles.

Questions to ask before you promote an in-house service

Is the service a designated health service under 42 USC 1395nn(h)(6) and the current code list?
Has counsel confirmed that the arrangement meets the in-office ancillary services exception, including who furnishes it, where and how it is billed?
If it is MRI, CT or PET, is the written notice with the supplier list built into the referral process?
Does any material suggest that patients must use the in-house service?
Does any state where you practice require a written disclosure or a posted notice?
Is any discount, waiver or free item tied to using the service?
Are claims about speed, equipment and coverage accurate today?

Use and avoid

Use: “X-ray is available in our office, so you can have it done during your visit if you choose.”
Avoid: “All imaging must be done in our office.”
Use: “Your clinician will tell you about your options for lab work, including labs your plan covers.”
Avoid: “Outside labs delay your care.”
Use: “Basic metabolic panel results are back by the next business day.” only if your records show that on a normal day.
Avoid: “Free lab work for Medicare patients who test with us.”
Use: a supplier list for MRI, CT and PET that is current and easy to read.
Avoid: a supplier list that is out of date or only handed over on request.

An illustration

This example is invented. [Practice name] is a family medicine group that has opened an in-house lab and an X-ray room at its main address, and it plans an email to its patients and a new services page. Before launch, the practice manager asks counsel to confirm that both services meet the in-office ancillary services exception and whether the state requires any written disclosure. The page says the lab and X-ray are in the same building, lists the tests the lab runs on site and says patients may use any lab or imaging center their plan covers. The email describes the new services to existing patients and does not offer discounts. When a patient asks the front desk whether they can go to another lab, the staff member says yes and prints the order. The practice later adds ultrasound. The manager checks the code list and confirms the arrangement with counsel before it goes on the page.

Checklist

Check each promoted service against the designated health services list and the current code list.
Have counsel confirm the in-office ancillary services exception, or another exception, for each service.
Build the MRI, CT and PET notice and supplier list into the referral workflow, and update the list on a schedule.
Word pages, signs and emails as an option, with patient choice stated.
Check state disclosure laws, such as Fla. Stat. 456.052 and N.Y. Pub. Health Law 238-d, for each state you practice in.
Remove discounts, waivers and gifts tied to using the in-house service unless counsel has cleared them.
Confirm speed, equipment and coverage claims before publishing, and review them when anything changes.
Train staff on how to answer questions about going elsewhere.

How we help

We build websites, local and organic search, Google Ads and lead generation and an AI front desk for independent practices. For in-office ancillary services, that means service pages and patient emails that describe your in-house lab, imaging or therapy accurately, state patient choice plainly and leave the legal structure to your counsel. Our tools are built with HIPAA in mind. We confirm in writing what a BAA covers before any patient information flows through a tool, and if it is not covered, we do not route patient information through it. We are not a healthcare provider and we do not give legal or medical advice. For the wider rules, see our healthcare marketing rules guide.

Can we advertise our in-house lab or X-ray to our own patients?

Yes. Under HIPAA, describing a health-related service your own practice provides is excluded from the definition of marketing unless you are paid to make the communication (45 CFR 164.501). The arrangement itself must still meet a Stark exception for Medicare designated health services, such as the in-office ancillary services exception (42 USC 1395nn(b)(2); 42 CFR 411.355(b)).

What must the MRI, CT or PET notice say?

That the patient may receive the same services from someone else, with a list of at least 5 other suppliers within a 25-mile radius of the referring physician’s office, including at least each supplier’s name, address and telephone number. It is given in writing at the time of the referral (42 CFR 411.355(b)(7)).

Does the notice rule apply to X-ray or ultrasound?

The federal written notice rule in 42 CFR 411.355(b)(7) covers MRI, CT and PET. X-ray and ultrasound are still designated health services when payable by Medicare (42 USC 1395nn(h)(6)), and state laws, such as Florida’s, can require disclosures for other services (Fla. Stat. 456.052).

Can we offer free lab work to bring patients to our in-house lab?

Be careful. The anti-kickback statute bars knowingly and willfully offering remuneration to induce referrals or orders paid by federal health care programs (42 USC 1320a-7b(b)(2)), and a civil law covers remuneration likely to influence Medicare or Medicaid patients to choose a particular provider (42 USC 1320a-7a(a)(5)). Have counsel review any free or discounted offer before it runs.

Do we have to tell patients they can go elsewhere?

For MRI, CT and PET under the in-office ancillary services exception, yes, in writing (42 CFR 411.355(b)(7)). Florida and New York require disclosure of patient choice in the referrals their laws cover (Fla. Stat. 456.052; N.Y. Pub. Health Law 238-d). For other services, no federal rule we found requires it in marketing. We recommend stating it anyway, because Medicare patients may obtain services from any qualified participating provider (42 USC 1395a(a)).

Promoting in-office lab, imaging and therapy services to your own patients