[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: 42CFR412.88]

[Page 410]
 
                         TITLE 42--PUBLIC HEALTH
 
                             HUMAN SERVICES
 
PART 412--PROSPECTIVE PAYMENT SYSTEMS FOR INPATIENT HOSPITAL SERVICES--Table of Contents
 
 Subpart F--Payment for Outlier Cases and Special Treatment Payment for 
                             New Technology
 
Sec. 412.88  Additional payment for new medical service or technology.

    (a) For discharges involving new medical services or technologies 
that meet the criteria specified in Sec. 412.87, Medicare payment will 
be:
    (1) One of the following:
    (i) The full DRG payment (including adjustments for indirect medical 
education and disproportionate share but excluding outlier payments);
    (ii) The payment determined under Sec. 412.4(f) for transfer cases;
    (iii) The payment determined under Sec. 412.92(d) for sole community 
hospitals; or
    (iv) The payment determined under Sec. 412.108(c) for Medicare-
dependent hospitals; plus
    (2) If the costs of the discharge (determined by applying cost-to-
charge ratios as described in Sec. 412.84(h)) exceed the full DRG 
payment, an additional amount equal to the lesser of--
    (i) 50 percent of the costs of the new medical service or 
technology; or
    (ii) 50 percent of the amount by which the costs of the case exceed 
the standard DRG payment.
    (b) Unless a discharge case qualifies for outlier payment under 
Sec. 412.84, Medicare will not pay any additional amount beyond the DRG 
payment plus 50 percent of the estimated costs of the new medical 
service or technology.
    (c) If CMS estimates before the beginning of a Federal fiscal year 
that the additional payments under this section would exceed 1.0 percent 
of total operating payments under the hospital inpatient prospective 
payment system, the additional payment amounts under paragraph (a) of 
this section will be reduced prospectively to a percentage estimated to 
result in payments not to exceed 1.0 percent of total operating payments 
under the hospital inpatient prospective payment system.

[66 FR 46924, Sept. 7, 2001, as amended at 67 FR 50111, Aug. 1, 2002]