[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: 42CFR410.12]



[Page 319-320]

 

                         TITLE 42--PUBLIC HEALTH

 

                    CHAPTER IV--CENTERS FOR MEDICARE

                          & MEDICAID SERVICES,

                        DEPARTMENT OF HEALTH AND

                             HUMAN SERVICES

 

PART 410_SUPPLEMENTARY MEDICAL INSURANCE (SMI) BENEFITS--Table of Contents

 

               Subpart B_Medical and Other Health Services

 

Sec. 410.12  Medical and other health services: Basic conditions and 

limitations.



    (a) Basic conditions. The medical and other health services 

specified in Sec. 410.10 are covered by Medicare Part B only if they 

are not excluded under subpart A of part 411 of this chapter, and if 

they meet the following conditions:

    (1) When the services must be furnished. The services must be 

furnished while the individual is in a period of entitlement. (The rules 

on entitlement are set forth in part 406 of this chapter.)

    (2) By whom the services must be furnished. The services must be 

furnished by a facility or other entity as specified in Sec. Sec. 

410.14 through 410.69.



[[Page 320]]



    (3) Physician certification and recertification requirements. If the 

services are subject to physician certification requirements, they must 

be certified as being medically necessary, and as meeting other 

applicable requirements, in accordance with subpart B of part 424 of 

this chapter.

    (b) Limitations on payment. Payment for medical and other health 

services is subject to limitations on the amounts of payment as 

specified in Sec. Sec. 410.152 and 410.155 and to the annual and blood 

deductibles as set forth in Sec. Sec. 410.160 and 410.161.



[51 FR 41339, Nov. 14, 1986, as amended at 53 FR 6648, Mar. 2, 1988; 57 

FR 33896, July 31, 1992]