[Code of Federal Regulations] [Title 42, Volume 2] [Revised as of October 1, 2007] From the U.S. Government Printing Office via GPO Access [CITE: 42CFR410.1] [Page 322-324] TITLE 42--PUBLIC HEALTH HUMAN SERVICES PART 410_SUPPLEMENTARY MEDICAL INSURANCE (SMI) BENEFITS--Table of Contents Subpart A_General Provisions Sec. 410.1 Basis and scope. Subpart A_General Provisions Sec. 410.1 Basis and scope. 410.2 Definitions. 410.3 Scope of benefits. 410.5 Other applicable rules. Subpart B_Medical and Other Health Services 410.10 Medical and other health services: Included services. 410.12 Medical and other health services: Basic conditions and limitations. 410.14 Special requirements for services furnished outside the United States. 410.16 Initial preventive physical examination: Conditions for and limitations on coverage. 410.17 Cardiovascular disease screening tests. 410.18 Diabetes screening tests. 410.19 Ultrasound screening for abdominal aortic aneurysms: Condition for and limitation on coverage. 410.20 Physicians' services. 410.21 Limitations on services of a chiropractor. 410.22 Limitations on services of an optometrist. 410.23 Screening for glaucoma: Conditions for and limitations on coverage 410.24 Limitations on services of a doctor of dental surgery or dental medicine. 410.25 Limitations on services of a podiatrist. 410.26 Services and supplies incident to a physician's professional services: Conditions. 410.27 Outpatient hospital services and supplies incident to a physician service: Conditions. 410.28 Hospital or CAH diagnostic services furnished to outpatients: Conditions. 410.29 Limitations on drugs and biologicals. 410.30 Prescription drugs used in immunosuppressive therapy. 410.31 Bone mass measurement: Conditions for coverage and frequency standards. 410.32 Diagnostic X-ray tests, diagnostic laboratory tests, and other diagnostic tests: Conditions. 410.33 Independent diagnostic testing facility. 410.34 Mammography services: Conditions for and limitations on coverage. 410.35 X-ray therapy and other radiation therapy services: Scope. 410.36 Medical supplies, appliances, and devices: Scope. 410.37 Colorectal cancer screening tests: Conditions for and limitations on coverage. [[Page 323]] 410.38 Durable medical equipment: Scope and conditions. 410.39 Prostate cancer screening tests: Conditions for and limitations on coverage. 410.40 Coverage of ambulance services. 410.41 Requirements for ambulance suppliers. 410.42 Limitations on coverage of certain services furnished to hospital outpatients. 410.43 Partial hospitalization services: Conditions and exclusions. 410.45 Rural health clinic services: Scope and conditions. 410.46 Physician and other practitioner services furnished in or at the direction of an IHS or Indian tribal hospital or clinic: Scope and conditions. 410.50 Institutional dialysis services and supplies: Scope and conditions. 410.52 Home dialysis services, supplies, and equipment: Scope and conditions. 410.55 Services related to kidney donations: Conditions. 410.56 Screening pelvic examinations. 410.57 Pneumococcal vaccine and flu vaccine. 410.58 Additional services to HMO and CMP enrollees. 410.59 Outpatient occupational therapy services: Conditions. 410.60 Outpatient physical therapy services: Conditions. 410.61 Plan of treatment requirements for outpatient rehabilitation services. 410.62 Outpatient speech-language pathology services: Conditions and exclusions. 410.63 Hepatitis B vaccine and blood clotting factors: Conditions. 410.66 Emergency outpatient services furnished by a nonparticipating hospital and services furnished in a foreign country. 410.68 Antigens: Scope and conditions. 410.69 Services of a certified registered nurse anesthetist or an anesthesiologist's assistant: Basic rule and definitions. 410.71 Clinical psychologist services and services and supplies incident to clinical psychologist services. 410.73 Clinical social worker services. 410.74 Physician assistants' services. 410.75 Nurse practitioners' services. 410.76 Clinical nurse specialists' services. 410.77 Certified nurse-midwives' services: Qualifications and conditions. 410.78 Telehealth services. Subpart C_Home Health Services Under SMI 410.80 Applicable rules. Subpart D_Comprehensive Outpatient Rehabilitation Facility (CORF) Services 410.100 Included services. 410.102 Excluded services. 410.105 Requirements for coverage of CORF services. Subpart E_Community Mental Health Centers (CMHCs) Providing Partial Hospitalization Services 410.110 Requirements for coverage of partial hospitalization services by CMHCs. Subpart F [Reserved] Subpart G_Medical Nutrition Therapy 410.130 Definitions. 410.132 Medical nutrition therapy. 410.134 Provider qualifications. Subpart H_Outpatient Diabetes Self-Management Training and Diabetes Outcome Measurements 410.140 Definitions. 410.141 Outpatient diabetes self-management training. 410.142 CMS process for approving national accreditation organizations. 410.143 Requirements for approved accreditation organizations. 410.144 Quality standards for deemed entities. 410.145 Requirements for entities. 410.146 Diabetes outcome measurements. Subpart I_Payment of SMI Benefits 410.150 To whom payment is made. 410.152 Amounts of payment. 410.155 Outpatient mental health treatment limitation. 410.160 Part B annual deductible. 410.161 Part B blood deductible. 410.163 Payment for services furnished to kidney donors. 410.165 Payment for rural health clinic services and ambulatory surgical center services: Conditions. 410.170 Payment for home health services, for medical and other health services furnished by a provider or an approved ESRD facility, and for comprehensive outpatient rehabilitation facility (CORF) services: Conditions. 410.172 Payment for partial hospitalization services in CMHCs: Conditions. 410.175 Alien absent from the United States. Authority: Secs. 1102, 1834, 1871, and 1893 of the Social Security Act (42 U.S.C. 1302, 1395m, 1395hh, and 1395ddd). Source: 51 FR 41339, Nov. 14, 1986, unless otherwise noted. [[Page 324]] Editorial Note: Nomenclature changes to part 410 appear at 62 FR 46037, Aug. 29, 1997. (a) Statutory basis. This part is based on the indicated provisions of the following sections of the Act: (1) Section 1832--Scope of benefits furnished under the Medicare Part B supplementary medical insurance (SMI) program. (2) Section 1833 through 1835 and 1862--Amounts of payment for SMI services, the conditions for payment, and the exclusions from coverage. (3) Section 1861(qq)--Definition of the kinds of services that may be covered. (4) Section 1865(b)--Permission for CMS to approve and recognize a national accreditation organization for the purpose of deeming entities accredited by the organization to meet program requirements. (5) Section 1881--Medicare coverage for end-stage renal disease beneficiaries. (6) Section 1842(o)--Payment for drugs and biologicals not paid on a cost or prospective payment basis. (b) Scope of part. This part sets forth the benefits available under Medicare Part B, the conditions for payment and the limitations on services, the percentage of incurred expenses that Medicare Part B pays, and the deductible and copayment amounts for which the beneficiary is responsible. (Exclusions applicable to these services are set forth in subpart C of part 405 of this chapter. General conditions for Medicare payment are set forth in part 424 of this chapter.) [51 FR 41339, Nov. 14, 1986, as amended at 53 FR 6648, Mar. 2, 1988; 55 FR 53521, Dec. 31, 1990; 59 FR 63462, Dec. 8, 1994; 63 FR 58905, Nov. 2, 1998; 65 FR 83148, Dec. 29, 2000; 69 FR 66420, Nov. 15, 2004]