[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: 42CFR410.3]



[Page 318]

 

                         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 A_General Provisions

 

Sec. 410.3  Scope of benefits.



    (a) Covered services. The SMI program helps pay for the following:

    (1) Medical and other health services such as physicians' services, 

outpatient services furnished by a hospital or a CAH, diagnostic tests, 

outpatient physical therapy and speech pathology services, rural health 

clinic services, Federally qualified health center services, IHS, Indian 

tribe, or tribal organization facility services, and outpatient renal 

dialysis services.

    (2) Services furnished by ambulatory surgical centers (ASCs), home 

health agencies (HHAs), comprehensive outpatient rehabilitation 

facilities (CORFs), and partial hospitalization services provided by 

community mental health centers (CMHCs).

    (3) Other medicial services, equipment, and supplies that are not 

covered under Medicare Part A hospital insurance.

    (b) Limitations on amount of payment. (1) Medicare Part B does not 

pay the full reasonable costs or charges for all covered services. The 

beneficiary is responsible for an annual deductible and a blood 

deductible and, after the annual deductible has been satisfied, for 

coinsurance amounts specified for most of the services.

    (2) Specific rules on payment are set forth in subpart E of this 

part.



[51 FR 41339, Nov. 14, 1986, as amended at 57 FR 24981, June 12, 1992; 

58 FR 30668, May 26, 1993; 59 FR 6577, Feb. 11, 1994; 66 FR 55328, Nov. 

1, 2001]