[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: 42CFR410.27]



[Page 325]

 

                         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. 410.27  Outpatient hospital services and supplies incident to a 

physician service: Conditions.



    (a) Medicare Part B pays for hospital services and supplies 

furnished incident to a physician service to outpatients, including 

drugs and biologicals that cannot be self-administered, if--

    (1) They are furnished--

    (i) By or under arrangements made by a participating hospital, 

except in the case of an SNF resident as provided in Sec. 411.15(p) of 

this chapter;

    (ii) As an integral though incidental part of a physician's 

services; and

    (iii) In the hospital or at a location (other than an RHC or an 

FQHC) that CMS designates as a department of a provider under Sec. 

413.65 of this chapter; and

    (2) In the case of partial hospitalization services, also meet the 

conditions of paragraph (d) of this section.

    (b) Drugs and biologicals are also subject to the limitations 

specified in Sec. 410.168.

    (c) Rules on emergency services furnished to outpatients by 

nonparticipating hospitals are specified in Sec. 410.168.

    (d) Medicare Part B pays for partial hospitalization services if 

they are--

    (1) Prescribed by a physician who certifies and recertifies the need 

for the services in accordance with subpart B of part 424 of this 

chapter; and

    (2) Furnished under a plan of treatment as required under subpart B 

of part 424 of this chapter.

    (e) Services furnished by an entity other than the hospital are 

subject to the limitations specified in Sec. 410.42(a).

    (f) Services furnished at a location (other than an RHC or an FQHC) 

that CMS designates as a department of a provider under Sec. 413.65 of 

this chapter must be under the direct supervision of a physician. 

``Direct supervision'' means the physician must be present and on the 

premises of the location and immediately available to furnish assistance 

and direction throughout the performance of the procedure. It does not 

mean that the physician must be present in the room when the procedure 

is performed.



[56 FR 8841, Mar. 1, 1991, as amended at 63 FR 26307, May 12, 1998; 65 

FR 18536, Apr. 7, 2000]