[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: 42CFR416.1]



[Page 809-810]

 

                         TITLE 42--PUBLIC HEALTH

 

                    CHAPTER IV--CENTERS FOR MEDICARE

                          & MEDICAID SERVICES,

                        DEPARTMENT OF HEALTH AND

                             HUMAN SERVICES

 

PART 416_AMBULATORY SURGICAL SERVICES--Table of Contents

 

              Subpart A_General Provisions and Definitions

 

Sec. 416.1  Basis and scope.









              Subpart A_General Provisions and Definitions



Sec.

416.1 Basis and scope.

416.2 Definitions.



              Subpart B_General Conditions and Requirements



416.25 Basic requirements.

416.26 Qualifying for an agreement.

416.30 Terms of agreement with CMS.



[[Page 810]]



416.35 Termination of agreement.



               Subpart C_Specific Conditions for Coverage



416.40 Condition for coverage--Compliance with State licensure law.

416.41 Condition for coverage--Governing body and management.

416.42 Condition for coverage--Surgical services.

416.43 Condition for coverage--Evaluation of quality.

416.44 Condition for coverage--Environment.

416.45 Condition for coverage--Medical staff.

416.46 Condition for coverage--Nursing services.

416.47 Condition for coverage--Medical records.

416.48 Condition for coverage--Pharmaceutical services.

416.49 Condition for coverage--Laboratory and radiologic services.



                       Subpart D_Scope of Benefits



416.60 General rules.

416.61 Scope of facility services.

416.65 Covered surgical procedures.

416.75 Performance of listed surgical procedures on an inpatient 

          hospital basis.



                 Subpart E_Payment for Facility Services



416.120 Basis for payment.

416.125 ASC facility services payment rate.

416.130 Publication of revised payment methodologies.

416.140 Surveys.

416.150 Beneficiary appeals.



 Subpart F_Adjustment in Payment Amounts for New Technology Intraocular 

             Lenses Furnished by Ambulatory Surgical Centers



416.180 Definitions.

416.185 Payment review process.

416.190 Who may request a review.

416.195 A request to review.

416.200 Application of the payment adjustment.



    Authority: Secs. 1102 and 1871 of the Social Security Act (42 U.S.C. 

1302 and 1395hh).



    Source: 47 FR 34094, Aug. 5, 1982, unless otherwise noted.







    (a) Statutory basis. (1) Section 1832(a)(2)(F)(i) of the Act 

provides for Medicare Part B coverage of facility services furnished in 

connection with surgical procedures specified by the Secretary under 

section 1833(i)(1) of the Act.

    (2) Section 1833(i)(1)(A) of the Act requires the Secretary to 

specify the surgical procedures that can be performed safely on an 

ambulatory basis in an ambulatory surgical center, or a hospital 

outpatient department.

    (3) Section 1833(i) (2)(A) and (3) specify the amounts to be paid 

for facility services furnished in connection with the specified 

surgical procedures when they are performed, respectively, in an ASC, or 

in a hospital outpatient department.

    (b) Scope. This part sets forth--

    (1) The conditions that an ASC must meet in order to participate in 

the Medicare program;

    (2) The scope of covered services; and

    (3) The conditions for Medicare payment for facility services.



[56 FR 8843, Mar. 1, 1991; 56 FR 23022, May 20, 1991]