[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: 42CFR412.50]



[Page 480]

 

                         TITLE 42--PUBLIC HEALTH

 

                    CHAPTER IV--CENTERS FOR MEDICARE

                          & MEDICAID SERVICES,

                        DEPARTMENT OF HEALTH AND

                             HUMAN SERVICES

 

PART 412_PROSPECTIVE PAYMENT SYSTEMS FOR INPATIENT HOSPITAL SERVICES

--Table of Contents

 

 Subpart C_Conditions for Payment Under the Prospective Payment Systems 

    for Inpatient Operating Costs and Inpatient Capital-Related Costs

 

Sec. 412.50  Furnishing of inpatient hospital services directly or under 

arrangements.



    (a) The applicable payments made under the prospective payment 

systems, as described in subparts H and M of this part, are payment in 

full for all inpatient hospital services, as defined in Sec. 409.10 of 

this chapter. Inpatient hospital services do not include the following 

types of 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 of this 

chapter.

    (b) CMS does not pay any provider or supplier other than the 

hospital for services furnished to a beneficiary who is an inpatient, 

except for the services described in paragraphs (a)(1) through (a)(6) of 

this section.

    (c) The hospital must furnish all necessary covered services to the 

beneficiary either directly or under arrangements (as defined in Sec. 

409.3 of this chapter).



[50 FR 12741, Mar. 29, 1985, as amended at 53 FR 38527, Sept. 30, 1988; 

57 FR 39821, Sept. 1, 1992; 60 FR 63188, Dec. 8, 1995; 65 FR 18537, Apr. 

7, 2000]