[Code of Federal Regulations]

[Title 42, Volume 2]

[Revised as of October 1, 2005]

From the U.S. Government Printing Office via GPO Access

[CITE: 42CFR405.500]



[Page 106-107]

 

                         TITLE 42--PUBLIC HEALTH

 

                    CHAPTER IV--CENTERS FOR MEDICARE

                          & MEDICAID SERVICES,

                        DEPARTMENT OF HEALTH AND

                             HUMAN SERVICES

 

PART 405_FEDERAL HEALTH INSURANCE FOR THE AGED AND DISABLED--Table of 

Contents

 

          Subpart E_Criteria for Determining Reasonable Charges

 

Sec. 405.500  Basis.



    Authority: Secs. 1102 and 1871 of the Social Security Act (42 U.S.C. 

1302 and 1395hh).



    Source: 32 FR 12599, Aug. 31, 1967, unless otherwise noted. 

Redesignated at 42 FR 52826, Sept. 30, 1977.





    Subpart E is based on the provisions of the following sections of 

the Act: Section 1814(b) provides for Part A payment on the basis of the 

lesser of a provider's reasonable costs or customary charges. Section 

1832 establishes the scope of benefits provided under the Part B 

supplementary medical insurance program. Section 1833(a) sets forth the 

amounts of payment for supplementary medical insurance services on the 

basis of the lesser of a provider's reasonable costs or customary 

charges. Section 1834(a) specifies how payments are made for the 

purchase or rental of new and used durable medical equipment for 

Medicare beneficiaries. Section 1834(b) provides for payment for 

radiologist services on a fee schedule basis. Section 1834(c) provides 

for payments and standards for screening mammography. Section 1842(b) 

sets forth the provisions for a carrier to enter into a contract with 

the Secretary and to make determinations



[[Page 107]]



with respect to Part B claims. Section 1842(h) sets forth the 

requirements for a physician or supplier to voluntarily enter into an 

agreement with the Secretary to become a participating physician or 

supplier. Section 1842(i) sets forth the provisions for the payment of 

Part B claims. Section 1848 establishes a fee schedule for payment of 

physician services. Section 1861(b) sets forth the inpatient hospital 

services covered by the Medicare program. Section 1861(s) sets forth 

medical and other health services covered by the Medicare program. 

Section 1861(v) sets forth the general authority under which CMS may 

establish limits on provider costs recognized as reasonable in 

determining Medicare program payments. Section 1861(aa) sets forth the 

rural health clinic services and Federally qualified health center 

services covered by the Medicare program. Section 1861(jj) defines the 

term ``covered osteoporosis drug.'' Section 1862(a)(14) lists services 

that are excluded from coverage. Section 1866(a) specifies the terms for 

provider agreements. Section 1881 authorizes special rules for the 

coverage of and payment for services furnished to patients with end-

stage renal disease. Section 1886 sets forth the requirements for 

payment to hospitals for inpatient hospital services. Section 1887 sets 

forth requirements for payment of provider-based physicians and payment 

under certain percentage arrangements. Section 1889 provides for 

Medicare and Medigap information by telephone.



[60 FR 63175, Dec. 8, 1995]