[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: 42CFR411.40]



[Page 392]

 

                         TITLE 42--PUBLIC HEALTH

 

                    CHAPTER IV--CENTERS FOR MEDICARE

                          & MEDICAID SERVICES,

                        DEPARTMENT OF HEALTH AND

                             HUMAN SERVICES

 

PART 411_EXCLUSIONS FROM MEDICARE AND LIMITATIONS ON MEDICARE PAYMENT

--Table of Contents

 

  Subpart C_Limitations on Medicare Payment for Services Covered Under 

                          Workers' Compensation

 

Sec. 411.40  General provisions.





    (a) Definition. ``Workers' compensation plan of the United States'' 

includes the workers' compensation plans of the 50 States, the District 

of Columbia, American Samoa, Guam, Puerto Rico, and the Virgin Islands, 

as well as the systems provided under the Federal Employees' 

Compensation Act and the Longshoremen's and Harbor Workers' Compensation 

Act.

    (b) Limitations on Medicare payment. (1) Medicare does not pay for 

any services for which--

    (i) Payment has been made, or can reasonably be expected to be made 

promptly under a workers' compensation law or plan of the United States 

or a state; or

    (ii) Payment could be made under the Federal Black Lung Program, but 

is precluded solely because the provider of the services has failed to 

secure, from the Department of Labor, a provider number to include in 

the claim.

    (2) If the payment for a service may not be made under workers' 

compensation because the service is furnished by a source not authorized 

to provide that service under the particular workers' compensation 

program, Medicare pays for the service if it is a covered service.

    (3) Medicare makes secondary payments in accordance with Sec. 

411.32 and Sec. 411.33.