[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: 42CFR410.42]



[Page 340]

 

                         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. 410.42  Limitations on coverage of certain services furnished 

to hospital outpatients.



    (a) General rule. Except as provided in paragraph (b) of this 

section, Medicare Part B does not pay for any item or service that is 

furnished to a hospital outpatient (as defined in Sec. 410.2) during an 

encounter (as defined in Sec. 410.2) by an entity other than the 

hospital unless the hospital has an arrangement (as defined in Sec. 

409.3 of this chapter) with that entity to furnish that particular 

service to its patients. As used in this paragraph, the term 

``hospital'' includes a CAH.

    (b) Exception. The limitations stated in paragraph (a) of this 

section do not apply to the following services:

    (1) Physician services that meet the requirements of Sec. 

415.102(a) of this chapter for payment on a fee schedule basis.

    (2) Physician assistant services, as defined in section 

1861(s)(2)(K)(i) of the Act.

    (3) Nurse practitioner and clinical nurse specialist services, as 

defined in section 1861(s)(2)(K)(ii) of the Act.

    (4) Certified nurse mid-wife services, as defined in section 

1861(gg) of the Act.

    (5) Qualified psychologist services, as defined in section 1861(ii) 

of the Act.

    (6) Services of an anesthetist, as defined in Sec. 410.69.

    (7) Services furnished to SNF residents as defined in Sec. 

411.15(p) of this chapter.



[65 FR 18536, Apr. 7, 2000]