[Code of Federal Regulations]
[Title 42, Volume 2]
[Revised as of October 1, 2002]
From the U.S. Government Printing Office via GPO Access
[CITE: 42CFR410.28]

[Page 248-249]
 
                         TITLE 42--PUBLIC HEALTH
 
                             HUMAN SERVICES
 
PART 410--SUPPLEMENTARY MEDICAL INSURANCE (SMI) BENEFITS--Table of Contents
 
              Subpart B--Medical and Other Health Services
 
Sec. 410.28  Hospital or CAH diagnostic services furnished to outpatients: Conditions.

    (a) Medicare Part B pays for hospital or CAH diagnostic services 
furnished to

[[Page 249]]

outpatients, including drugs and biologicals required in the performance 
of the services (even if those drugs or biologicals are self-
administered), if those services meet the following conditions:
    (1) They are furnished by or under arrangements made by a 
participating hospital or participating CAH, except in the case of an 
SNF resident as provided in Sec. 411.15(p) of this chapter.
    (2) They are ordinarily furnished by, or under arrangements made by, 
the hospital or CAH to its outpatients for the purpose of diagnostic 
study.
    (3) They would be covered as inpatient hospital services if 
furnished to an inpatient.
    (b) Drugs and biologicals are also subject to the limitations 
specified in Sec. 410.29(b) and (c).
    (c) Diagnostic services furnished by an entity other than the 
hospital or CAH are subject to the limitations specified in 
Sec. 410.42(a).
    (d) Rules on emergency services furnished to outpatients by 
nonparticipating hospitals are set forth in subpart G of part 424 of 
this chapter.
    (e) Medicare Part B makes payment under section 1833(t) of the Act 
for diagnostic services furnished at a facility (other than an RHC or an 
FQHC) that CMS designates as having provider-based status only when the 
diagnostic services are furnished under the appropriate level of 
physician supervision specified by CMS in accordance with the 
definitions in Sec. 410.32(b)(3)(i), (b)(3)(ii), and (b)(3)(iii). Under 
general supervision at a facility accorded provider-based status, the 
training of the nonphysician personnel who actually perform the 
diagnostic procedure and the maintenance of the necessary equipment and 
supplies are the continuing responsibility of the facility.
    (f) The rules for clinical diagnostic laboratory tests set forth in 
Secs. 410.32(a) and (d)(2) through (d)(4) of this subpart are applicable 
to those tests when furnished in hospitals and CAHs.

[51 FR 41339, Nov. 14, 1986, as amended at 58 FR 30668, May 26, 1993; 63 
FR 26307, May 12, 1998; 65 FR 18536, Apr. 7, 2000; 66 FR 58809, Nov. 23, 
2001]