[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: 42CFR410.28]



[Page 325-326]

 

                         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. 410.28  Hospital or CAH diagnostic services furnished to outpatients: 

Conditions.



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

furnished to 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



[[Page 326]]



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 

Sec. Sec. 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]