Title 42

PART 405

Part 405 - Federal Health Insurance For The Aged And Disabled

PART 405 - FEDERAL HEALTH INSURANCE FOR THE AGED AND DISABLED Authority:42 U.S.C. 263a, 405(a), 1302, 1320b-12, 1395x, 1395y(a), 1395ff, 1395hh, 1395kk, 1395rr, and 1395ww(k).

• Authority: 42 U.S.C. 263a, 405(a), 1302, 1320b-12, 1395x, 1395y(a), 1395ff, 1395hh, 1395kk, 1395rr, and 1395ww(k).

42:2.0.1.2.6.1	SUBPART A	Subpart A [Reserved]
42:2.0.1.2.6.2	SUBPART B	Subpart B - Medical Services Coverage Decisions That Relate to Health Care Technology
42:2.0.1.2.6.2.21.1	SECTION 405.201	405.201 Scope of subpart and definitions.
42:2.0.1.2.6.2.21.2	SECTION 405.203	405.203 FDA categorization of investigational devices.
42:2.0.1.2.6.2.21.3	SECTION 405.205	405.205 Coverage of a Category B (Nonexperimental/investigational) device.
42:2.0.1.2.6.2.21.4	SECTION 405.207	405.207 Services related to a noncovered device.
42:2.0.1.2.6.2.21.5	SECTION 405.209	405.209 Payment for a Category B (Nonexperimental/investigational) device.
42:2.0.1.2.6.2.21.6	SECTION 405.211	405.211 Coverage of items and services in FDA-approved IDE studies.
42:2.0.1.2.6.2.21.7	SECTION 405.212	405.212 Medicare Coverage IDE study criteria.
42:2.0.1.2.6.2.21.8	SECTION 405.213	405.213 Re-evaluation of a device categorization.
42:2.0.1.2.6.2.21.9	SECTION 405.215	405.215 Confidential commercial and trade secret information.
42:2.0.1.2.6.3	SUBPART C	Subpart C - Suspension of Payment, Recovery of Overpayments, and Repayment of Scholarships and Loans
42:2.0.1.2.6.3.21	SUBJGRP 21	General Provisions
42:2.0.1.2.6.3.21.1	SECTION 405.301	405.301 Scope of subpart.
42:2.0.1.2.6.3.22	SUBJGRP 22	Liability for Payments To Providers or Suppliers and Handling of Incorrect Payments
42:2.0.1.2.6.3.22.2	SECTION 405.350	405.350 Individual's liability for payments made to providers and other persons for items and services furnished the individual.
42:2.0.1.2.6.3.22.3	SECTION 405.351	405.351 Incorrect payments for which the individual is not liable.
42:2.0.1.2.6.3.22.4	SECTION 405.352	405.352 Adjustment of title XVIII incorrect payments.
42:2.0.1.2.6.3.22.5	SECTION 405.353	405.353 Certification of amount that will be adjusted against individual title II or railroad retirement benefits.
42:2.0.1.2.6.3.22.6	SECTION 405.354	405.354 Procedures for adjustment or recovery - title II beneficiary.
42:2.0.1.2.6.3.22.7	SECTION 405.355	405.355 Waiver of adjustment or recovery.
42:2.0.1.2.6.3.22.8	SECTION 405.356	405.356 Principles applied in waiver of adjustment or recovery.
42:2.0.1.2.6.3.22.9	SECTION 405.357	405.357 Notice of right to waiver consideration.
42:2.0.1.2.6.3.22.10	SECTION 405.358	405.358 When waiver of adjustment or recovery may be applied.
42:2.0.1.2.6.3.22.11	SECTION 405.359	405.359 Liability of certifying or disbursing officer.
42:2.0.1.2.6.3.23	SUBJGRP 23	Suspension and Recoupment of Payment to Providers and Suppliers and Collection and Compromise of Overpayments
42:2.0.1.2.6.3.23.12	SECTION 405.370	405.370 Definitions.
42:2.0.1.2.6.3.23.13	SECTION 405.371	405.371 Suspension, offset, and recoupment of Medicare payments to providers and suppliers of services.
42:2.0.1.2.6.3.23.14	SECTION 405.372	405.372 Proceeding for suspension of payment.
42:2.0.1.2.6.3.23.15	SECTION 405.373	405.373 Proceeding for offset or recoupment.
42:2.0.1.2.6.3.23.16	SECTION 405.374	405.374 Opportunity for rebuttal.
42:2.0.1.2.6.3.23.17	SECTION 405.375	405.375 Time limits for, and notification of, administrative determination after receipt of rebuttal statement.
42:2.0.1.2.6.3.23.18	SECTION 405.376	405.376 Suspension and termination of collection action and compromise of claims for overpayment.
42:2.0.1.2.6.3.23.19	SECTION 405.377	405.377 Withholding Medicare payments to recover Medicaid overpayments.
42:2.0.1.2.6.3.23.20	SECTION 405.378	405.378 Interest charges on overpayment and underpayments to providers, suppliers, and other entities.
42:2.0.1.2.6.3.23.21	SECTION 405.379	405.379 Limitation on recoupment of provider and supplier overpayments.
42:2.0.1.2.6.3.24	SUBJGRP 24	Repayment of Scholarships and Loans
42:2.0.1.2.6.3.24.22	SECTION 405.380	405.380 Collection of past-due amounts on scholarship and loan programs.
42:2.0.1.2.6.4	SUBPART D	Subpart D - Private Contracts
42:2.0.1.2.6.4.25.1	SECTION 405.400	405.400 Definitions.
42:2.0.1.2.6.4.25.2	SECTION 405.405	405.405 General rules.
42:2.0.1.2.6.4.25.3	SECTION 405.410	405.410 Conditions for properly opting-out of Medicare.
42:2.0.1.2.6.4.25.4	SECTION 405.415	405.415 Requirements of the private contract.
42:2.0.1.2.6.4.25.5	SECTION 405.420	405.420 Requirements of the opt-out affidavit.
42:2.0.1.2.6.4.25.6	SECTION 405.425	405.425 Effects of opting-out of Medicare.
42:2.0.1.2.6.4.25.7	SECTION 405.430	405.430 Failure to properly opt-out.
42:2.0.1.2.6.4.25.8	SECTION 405.435	405.435 Failure to maintain opt-out.
42:2.0.1.2.6.4.25.9	SECTION 405.440	405.440 Emergency and urgent care services.
42:2.0.1.2.6.4.25.10	SECTION 405.445	405.445 Cancellation of opt-out and early termination of opt-out.
42:2.0.1.2.6.4.25.11	SECTION 405.450	405.450 Appeals.
42:2.0.1.2.6.4.25.12	SECTION 405.455	405.455 Application to Medicare Advantage contracts.
42:2.0.1.2.6.5	SUBPART E	Subpart E - Criteria for Determining Reasonable Charges
42:2.0.1.2.6.5.25.1	SECTION 405.500	405.500 Basis.
42:2.0.1.2.6.5.25.2	SECTION 405.501	405.501 Determination of reasonable charges.
42:2.0.1.2.6.5.25.3	SECTION 405.502	405.502 Criteria for determining reasonable charges.
42:2.0.1.2.6.5.25.4	SECTION 405.503	405.503 Determining customary charges.
42:2.0.1.2.6.5.25.5	SECTION 405.504	405.504 Determining prevailing charges.
42:2.0.1.2.6.5.25.6	SECTION 405.505	405.505 Determination of locality.
42:2.0.1.2.6.5.25.7	SECTION 405.506	405.506 Charges higher than customary or prevailing charges or lowest charge levels.
42:2.0.1.2.6.5.25.8	SECTION 405.507	405.507 Illustrations of the application of the criteria for determining reasonable charges.
42:2.0.1.2.6.5.25.9	SECTION 405.508	405.508 Determination of comparable circumstances; limitation.
42:2.0.1.2.6.5.25.10	SECTION 405.509	405.509 Determining the inflation-indexed charge.
42:2.0.1.2.6.5.25.11	SECTION 405.511	405.511 Reasonable charges for medical services, supplies, and equipment.
42:2.0.1.2.6.5.25.12	SECTION 405.512	405.512 Carriers' procedural terminology and coding systems.
42:2.0.1.2.6.5.25.13	SECTION 405.515	405.515 Reimbursement for clinical laboratory services billed by physicians.
42:2.0.1.2.6.5.25.14	SECTION 405.517	405.517 Payment for drugs and biologicals that are not paid on a cost or prospective payment basis.
42:2.0.1.2.6.5.25.15	SECTION 405.520	405.520 Payment for a physician assistant's, nurse practitioner's, and clinical nurse specialists' services and services furnished incident to their professional services.
42:2.0.1.2.6.5.25.16	SECTION 405.534	405.534 Limitation on payment for screening mammography services.
42:2.0.1.2.6.5.25.17	SECTION 405.535	405.535 Special rule for nonparticipating physicians and suppliers furnishing screening mammography services before January 1, 2002.
42:2.0.1.2.6.6	SUBPART F	Subpart F - XXX
42:2.0.1.2.6.7	SUBPART G	Subpart G [Reserved]
42:2.0.1.2.6.8	SUBPART H	Subpart H - Appeals Under the Medicare Part B Program
42:2.0.1.2.6.8.25.1	SECTION 405.800	405.800 Appeals of CMS or a CMS contractor.
42:2.0.1.2.6.8.25.2	SECTION 405.803	405.803 Appeals rights.
42:2.0.1.2.6.8.25.3	SECTION 405.806	405.806 Impact of reversal of contractor determinations on claims processing.
42:2.0.1.2.6.8.25.4	SECTION 405.809	405.809 Reinstatement of provider or supplier billing privileges following corrective action.
42:2.0.1.2.6.8.25.5	SECTION 405.812	405.812 Effective date for DMEPOS supplier's billing privileges.
42:2.0.1.2.6.8.25.6	SECTION 405.815	405.815 Submission of claims.
42:2.0.1.2.6.8.25.7	SECTION 405.818	405.818 Deadline for processing provider enrollment initial determinations.
42:2.0.1.2.6.9	SUBPART I	Subpart I - Determinations, Redeterminations, Reconsiderations, and Appeals Under Original Medicare (Part A and Part B)
42:2.0.1.2.6.9.25	SUBJGRP 25	Initial Determinations
42:2.0.1.2.6.9.25.1	SECTION 405.900	405.900 Basis and scope.
42:2.0.1.2.6.9.25.2	SECTION 405.902	405.902 Definitions.
42:2.0.1.2.6.9.25.3	SECTION 405.904	405.904 Medicare initial determinations, redeterminations and appeals: General description.
42:2.0.1.2.6.9.25.4	SECTION 405.906	405.906 Parties to the initial determinations, redeterminations, reconsiderations, hearings, and reviews.
42:2.0.1.2.6.9.25.5	SECTION 405.908	405.908 Medicaid State agencies.
42:2.0.1.2.6.9.25.6	SECTION 405.910	405.910 Appointed representatives.
42:2.0.1.2.6.9.25.7	SECTION 405.912	405.912 Assignment of appeal rights.
42:2.0.1.2.6.9.25.8	SECTION 405.920	405.920 Initial determinations.
42:2.0.1.2.6.9.25.9	SECTION 405.921	405.921 Notice of initial determination.
42:2.0.1.2.6.9.25.10	SECTION 405.922	405.922 Time frame for processing initial determinations.
42:2.0.1.2.6.9.25.11	SECTION 405.924	405.924 Actions that are initial determinations.
42:2.0.1.2.6.9.25.12	SECTION 405.925	405.925 Decisions of utilization review committees.
42:2.0.1.2.6.9.25.13	SECTION 405.926	405.926 Actions that are not initial determinations.
42:2.0.1.2.6.9.25.14	SECTION 405.927	405.927 Initial determinations subject to the reopenings process.
42:2.0.1.2.6.9.25.15	SECTION 405.928	405.928 Effect of the initial determination.
42:2.0.1.2.6.9.26	SUBJGRP 26	Redeterminations
42:2.0.1.2.6.9.26.16	SECTION 405.940	405.940 Right to a redetermination.
42:2.0.1.2.6.9.26.17	SECTION 405.942	405.942 Time frame for filing a request for a redetermination.
42:2.0.1.2.6.9.26.18	SECTION 405.944	405.944 Place and method of filing a request for a redetermination.
42:2.0.1.2.6.9.26.19	SECTION 405.946	405.946 Evidence to be submitted with the redetermination request.
42:2.0.1.2.6.9.26.20	SECTION 405.947	405.947 Notice to the beneficiary of applicable plan's request for a redetermination.
42:2.0.1.2.6.9.26.21	SECTION 405.948	405.948 Conduct of a redetermination.
42:2.0.1.2.6.9.26.22	SECTION 405.950	405.950 Time frame for making a redetermination.
42:2.0.1.2.6.9.26.23	SECTION 405.952	405.952 Withdrawal or dismissal of a request for a redetermination.
42:2.0.1.2.6.9.26.24	SECTION 405.954	405.954 Redetermination.
42:2.0.1.2.6.9.26.25	SECTION 405.956	405.956 Notice of a redetermination.
42:2.0.1.2.6.9.26.26	SECTION 405.958	405.958 Effect of a redetermination.
42:2.0.1.2.6.9.27	SUBJGRP 27	Reconsideration
42:2.0.1.2.6.9.27.27	SECTION 405.960	405.960 Right to a reconsideration.
42:2.0.1.2.6.9.27.28	SECTION 405.962	405.962 Timeframe for filing a request for a reconsideration.
42:2.0.1.2.6.9.27.29	SECTION 405.964	405.964 Place and method of filing a request for a reconsideration.
42:2.0.1.2.6.9.27.30	SECTION 405.966	405.966 Evidence to be submitted with the reconsideration request.
42:2.0.1.2.6.9.27.31	SECTION 405.968	405.968 Conduct of a reconsideration.
42:2.0.1.2.6.9.27.32	SECTION 405.970	405.970 Timeframe for making a reconsideration following a contractor redetermination.
42:2.0.1.2.6.9.27.33	SECTION 405.972	405.972 Withdrawal or dismissal of a request for reconsideration or review of a contractor's dismissal of a request for redetermination.
42:2.0.1.2.6.9.27.34	SECTION 405.974	405.974 Reconsideration and review of a contractor's dismissal of a request for redetermination.
42:2.0.1.2.6.9.27.35	SECTION 405.976	405.976 Notice of a reconsideration.
42:2.0.1.2.6.9.27.36	SECTION 405.978	405.978 Effect of a reconsideration.
42:2.0.1.2.6.9.28	SUBJGRP 28	Reopenings
42:2.0.1.2.6.9.28.37	SECTION 405.980	405.980 Reopening of initial determinations, redeterminations, reconsiderations, decisions, and reviews.
42:2.0.1.2.6.9.28.38	SECTION 405.982	405.982 Notice of a revised determination or decision.
42:2.0.1.2.6.9.28.39	SECTION 405.984	405.984 Effect of a revised determination or decision.
42:2.0.1.2.6.9.28.40	SECTION 405.986	405.986 Good cause for reopening.
42:2.0.1.2.6.9.29	SUBJGRP 29	Expedited Access to Judicial Review
42:2.0.1.2.6.9.29.41	SECTION 405.990	405.990 Expedited access to judicial review.
42:2.0.1.2.6.9.30	SUBJGRP 30	ALJ Hearings
42:2.0.1.2.6.9.30.42	SECTION 405.1000	405.1000 Hearing before an ALJ and decision by an ALJ or attorney adjudicator: General rule.
42:2.0.1.2.6.9.30.43	SECTION 405.1002	405.1002 Right to an ALJ hearing.
42:2.0.1.2.6.9.30.44	SECTION 405.1004	405.1004 Right to a review of QIC notice of dismissal.
42:2.0.1.2.6.9.30.45	SECTION 405.1006	405.1006 Amount in controversy required for an ALJ hearing and judicial review.
42:2.0.1.2.6.9.30.46	SECTION 405.1008	405.1008 Parties to the proceedings on a request for an ALJ hearing.
42:2.0.1.2.6.9.30.47	SECTION 405.1010	405.1010 When CMS or its contractors may participate in the proceedings on a request for an ALJ hearing.
42:2.0.1.2.6.9.30.48	SECTION 405.1012	405.1012 When CMS or its contractors may be a party to a hearing.
42:2.0.1.2.6.9.30.49	SECTION 405.1014	405.1014 Request for an ALJ hearing or a review of a QIC dismissal.
42:2.0.1.2.6.9.30.50	SECTION 405.1016	405.1016 Time frames for deciding an appeal of a QIC reconsideration or escalated request for a QIC reconsideration.
42:2.0.1.2.6.9.30.51	SECTION 405.1018	405.1018 Submitting evidence.
42:2.0.1.2.6.9.30.52	SECTION 405.1020	405.1020 Time and place for a hearing before an ALJ.
42:2.0.1.2.6.9.30.53	SECTION 405.1022	405.1022 Notice of a hearing before an ALJ.
42:2.0.1.2.6.9.30.54	SECTION 405.1024	405.1024 Objections to the issues.
42:2.0.1.2.6.9.30.55	SECTION 405.1026	405.1026 Disqualification of the ALJ or attorney adjudicator.
42:2.0.1.2.6.9.30.56	SECTION 405.1028	405.1028 Review of evidence submitted by parties.
42:2.0.1.2.6.9.30.57	SECTION 405.1030	405.1030 ALJ hearing procedures.
42:2.0.1.2.6.9.30.58	SECTION 405.1032	405.1032 Issues before an ALJ or attorney adjudicator.
42:2.0.1.2.6.9.30.59	SECTION 405.1034	405.1034 Requesting information from the QIC.
42:2.0.1.2.6.9.30.60	SECTION 405.1036	405.1036 Description of an ALJ hearing process.
42:2.0.1.2.6.9.30.61	SECTION 405.1037	405.1037 Discovery.
42:2.0.1.2.6.9.30.62	SECTION 405.1038	405.1038 Deciding a case without a hearing before an ALJ.
42:2.0.1.2.6.9.30.63	SECTION 405.1040	405.1040 Prehearing and posthearing conferences.
42:2.0.1.2.6.9.30.64	SECTION 405.1042	405.1042 The administrative record.
42:2.0.1.2.6.9.30.65	SECTION 405.1044	405.1044 Consolidated proceedings.
42:2.0.1.2.6.9.30.66	SECTION 405.1046	405.1046 Notice of an ALJ or attorney adjudicator decision.
42:2.0.1.2.6.9.30.67	SECTION 405.1048	405.1048 The effect of an ALJ's or attorney adjudicator's decision.
42:2.0.1.2.6.9.30.68	SECTION 405.1050	405.1050 Removal of a hearing request from OMHA to the Council.
42:2.0.1.2.6.9.30.69	SECTION 405.1052	405.1052 Dismissal of a request for a hearing before an ALJ or request for review of a QIC dismissal.
42:2.0.1.2.6.9.30.70	SECTION 405.1054	405.1054 Effect of dismissal of a request for a hearing or request for review of QIC dismissal.
42:2.0.1.2.6.9.30.71	SECTION 405.1056	405.1056 Remands of requests for hearing and requests for review.
42:2.0.1.2.6.9.30.72	SECTION 405.1058	405.1058 Effect of a remand.
42:2.0.1.2.6.9.31	SUBJGRP 31	Applicability of Medicare Coverage Policies
42:2.0.1.2.6.9.31.73	SECTION 405.1060	405.1060 Applicability of national coverage determinations (NCDs).
42:2.0.1.2.6.9.31.74	SECTION 405.1062	405.1062 Applicability of local coverage determinations and other policies not binding on the ALJ or attorney adjudicator and Council.
42:2.0.1.2.6.9.31.75	SECTION 405.1063	405.1063 Applicability of laws, regulations, CMS Rulings, and precedential decisions.
42:2.0.1.2.6.9.32	SUBJGRP 32	Medicare Appeals Council Review
42:2.0.1.2.6.9.32.76	SECTION 405.1100	405.1100 Medicare Appeals Council review: General.
42:2.0.1.2.6.9.32.77	SECTION 405.1102	405.1102 Request for Council review when ALJ or attorney adjudicator issues decision or dismissal.
42:2.0.1.2.6.9.32.78	SECTION 405.1106	405.1106 Where a request for review or escalation may be filed.
42:2.0.1.2.6.9.32.79	SECTION 405.1108	405.1108 Council actions when request for review or escalation is filed.
42:2.0.1.2.6.9.32.80	SECTION 405.1110	405.1110 Council reviews on its own motion.
42:2.0.1.2.6.9.32.81	SECTION 405.1112	405.1112 Content of request for review.
42:2.0.1.2.6.9.32.82	SECTION 405.1114	405.1114 Dismissal of request for review.
42:2.0.1.2.6.9.32.83	SECTION 405.1116	405.1116 Effect of dismissal of request for Council review or request for hearing.
42:2.0.1.2.6.9.32.84	SECTION 405.1118	405.1118 Obtaining evidence from the Council.
42:2.0.1.2.6.9.32.85	SECTION 405.1120	405.1120 Filing briefs with the Council.
42:2.0.1.2.6.9.32.86	SECTION 405.1122	405.1122 What evidence may be submitted to the Council.
42:2.0.1.2.6.9.32.87	SECTION 405.1124	405.1124 Oral argument.
42:2.0.1.2.6.9.32.88	SECTION 405.1126	405.1126 Case remanded by the Council.
42:2.0.1.2.6.9.32.89	SECTION 405.1128	405.1128 Action of the Council.
42:2.0.1.2.6.9.32.90	SECTION 405.1130	405.1130 Effect of the Council's decision.
42:2.0.1.2.6.9.32.91	SECTION 405.1132	405.1132 Request for escalation to Federal court.
42:2.0.1.2.6.9.32.92	SECTION 405.1134	405.1134 Extension of time to file action in Federal district court.
42:2.0.1.2.6.9.32.93	SECTION 405.1136	405.1136 Judicial review.
42:2.0.1.2.6.9.32.94	SECTION 405.1138	405.1138 Case remanded by a Federal district court.
42:2.0.1.2.6.9.32.95	SECTION 405.1140	405.1140 Council review of ALJ decision in a case remanded by a Federal district court.
42:2.0.1.2.6.10	SUBPART J	Subpart J - Expedited Determinations and Reconsiderations of Provider Service Terminations, and Procedures for Inpatient Hospital Discharges
42:2.0.1.2.6.10.33.1	SECTION 405.1200	405.1200 Notifying beneficiaries of provider service terminations.
42:2.0.1.2.6.10.33.2	SECTION 405.1202	405.1202 Expedited determination procedures.
42:2.0.1.2.6.10.33.3	SECTION 405.1204	405.1204 Expedited reconsiderations.
42:2.0.1.2.6.10.33.4	SECTION 405.1205	405.1205 Notifying beneficiaries of hospital discharge appeal rights.
42:2.0.1.2.6.10.33.5	SECTION 405.1206	405.1206 Expedited determination procedures for inpatient hospital care.
42:2.0.1.2.6.10.33.6	SECTION 405.1208	405.1208 Hospital requests expedited QIO review.
42:2.0.1.2.6.11	SUBPART K	Subparts K-Q [Reserved]
42:2.0.1.2.6.12	SUBPART R	Subpart R - Provider Reimbursement Determinations and Appeals
42:2.0.1.2.6.12.33.1	SECTION 405.1801	405.1801 Introduction.
42:2.0.1.2.6.12.33.2	SECTION 405.1803	405.1803 Contractor determination and notice of amount of program reimbursement.
42:2.0.1.2.6.12.33.3	SECTION 405.1804	405.1804 Matters not subject to administrative and judicial review under prospective payment.
42:2.0.1.2.6.12.33.4	SECTION 405.1805	405.1805 Parties to contractor determination.
42:2.0.1.2.6.12.33.5	SECTION 405.1807	405.1807 Effect of contractor determination.
42:2.0.1.2.6.12.33.6	SECTION 405.1809	405.1809 Contractor hearing procedures.
42:2.0.1.2.6.12.33.7	SECTION 405.1811	405.1811 Right to contractor hearing; contents of, and adding issues to, hearing request.
42:2.0.1.2.6.12.33.8	SECTION 405.1813	405.1813 Good cause extension of time limit for requesting a contractor hearing.
42:2.0.1.2.6.12.33.9	SECTION 405.1814	405.1814 Contractor hearing officer jurisdiction.
42:2.0.1.2.6.12.33.10	SECTION 405.1815	405.1815 Parties to proceedings before the contractor hearing officer(s).
42:2.0.1.2.6.12.33.11	SECTION 405.1817	405.1817 Hearing officer or panel of hearing officers authorized to conduct contractor hearing; disqualification of officers.
42:2.0.1.2.6.12.33.12	SECTION 405.1819	405.1819 Conduct of contractor hearing.
42:2.0.1.2.6.12.33.13	SECTION 405.1821	405.1821 Prehearing discovery and other proceedings prior to the contractor hearing.
42:2.0.1.2.6.12.33.14	SECTION 405.1823	405.1823 Evidence at contractor hearing.
42:2.0.1.2.6.12.33.15	SECTION 405.1825	405.1825 Witnesses at contractor hearing.
42:2.0.1.2.6.12.33.16	SECTION 405.1827	405.1827 Record of proceedings before the contractor hearing officer(s).
42:2.0.1.2.6.12.33.17	SECTION 405.1829	405.1829 Scope of authority of contractor hearing officer(s).
42:2.0.1.2.6.12.33.18	SECTION 405.1831	405.1831 Contractor hearing decision.
42:2.0.1.2.6.12.33.19	SECTION 405.1832	405.1832 Contractor hearing officer review of compliance with the substantive reimbursement requirement of an appropriate cost report claim.
42:2.0.1.2.6.12.33.20	SECTION 405.1833	405.1833 Effect of contractor hearing decision.
42:2.0.1.2.6.12.33.21	SECTION 405.1834	405.1834 CMS reviewing official procedure.
42:2.0.1.2.6.12.33.22	SECTION 405.1835	405.1835 Right to Board hearing; contents of, and adding issues to, hearing request.
42:2.0.1.2.6.12.33.23	SECTION 405.1836	405.1836 Good cause extension of time limit for requesting a Board hearing.
42:2.0.1.2.6.12.33.24	SECTION 405.1837	405.1837 Group appeals.
42:2.0.1.2.6.12.33.25	SECTION 405.1839	405.1839 Amount in controversy.
42:2.0.1.2.6.12.33.26	SECTION 405.1840	405.1840 Board jurisdiction.
42:2.0.1.2.6.12.33.27	SECTION 405.1842	405.1842 Expedited judicial review.
42:2.0.1.2.6.12.33.28	SECTION 405.1843	405.1843 Parties to proceedings in a Board appeal.
42:2.0.1.2.6.12.33.29	SECTION 405.1845	405.1845 Composition of Board; hearings, decisions, and remands.
42:2.0.1.2.6.12.33.30	SECTION 405.1847	405.1847 Disqualification of Board members.
42:2.0.1.2.6.12.33.31	SECTION 405.1849	405.1849 Establishment of time and place of hearing by the Board.
42:2.0.1.2.6.12.33.32	SECTION 405.1851	405.1851 Conduct of Board hearing.
42:2.0.1.2.6.12.33.33	SECTION 405.1853	405.1853 Board proceedings prior to any hearing; discovery.
42:2.0.1.2.6.12.33.34	SECTION 405.1855	405.1855 Evidence at Board hearing.
42:2.0.1.2.6.12.33.35	SECTION 405.1857	405.1857 Subpoenas.
42:2.0.1.2.6.12.33.36	SECTION 405.1859	405.1859 Witnesses.
42:2.0.1.2.6.12.33.37	SECTION 405.1861	405.1861 Oral argument and written allegations.
42:2.0.1.2.6.12.33.38	SECTION 405.1863	405.1863 Administrative policy at issue.
42:2.0.1.2.6.12.33.39	SECTION 405.1865	405.1865 Record of administrative proceedings.
42:2.0.1.2.6.12.33.40	SECTION 405.1867	405.1867 Scope of Board's legal authority.
42:2.0.1.2.6.12.33.41	SECTION 405.1868	405.1868 Board actions in response to failure to follow Board rules.
42:2.0.1.2.6.12.33.42	SECTION 405.1869	405.1869 Scope of Board's authority in a hearing decision.
42:2.0.1.2.6.12.33.43	SECTION 405.1871	405.1871 Board hearing decision.
42:2.0.1.2.6.12.33.44	SECTION 405.1873	405.1873 Board review of compliance with the reimbursement requirement of an appropriate cost report claim.
42:2.0.1.2.6.12.33.45	SECTION 405.1875	405.1875 Administrator review.
42:2.0.1.2.6.12.33.46	SECTION 405.1877	405.1877 Judicial review.
42:2.0.1.2.6.12.33.47	SECTION 405.1881	405.1881 Appointment of representative.
42:2.0.1.2.6.12.33.48	SECTION 405.1883	405.1883 Authority of representative.
42:2.0.1.2.6.12.33.49	SECTION 405.1885	405.1885 Reopening a contractor determination or reviewing entity decision.
42:2.0.1.2.6.12.33.50	SECTION 405.1887	405.1887 Notice of reopening; effect of reopening.
42:2.0.1.2.6.12.33.51	SECTION 405.1889	405.1889 Effect of a revision; issue-specific nature of appeals of revised determinations and decisions.
42:2.0.1.2.6.13	SUBPART S	Subparts S-T [Reserved]
42:2.0.1.2.6.14	SUBPART U	Subpart U - Conditions for Coverage of Suppliers of End-Stage Renal Disease (ESRD) Services
42:2.0.1.2.6.14.33.1	SECTION 405.2100-405.2101	405.2100-405.2101 [Reserved]
42:2.0.1.2.6.14.33.2	SECTION 405.2102	405.2102 Definitions.
42:2.0.1.2.6.14.33.3	SECTION 405.2110	405.2110 Designation of ESRD networks.
42:2.0.1.2.6.14.33.4	SECTION 405.2111	405.2111 [Reserved]
42:2.0.1.2.6.14.33.5	SECTION 405.2112	405.2112 ESRD network organizations.
42:2.0.1.2.6.14.33.6	SECTION 405.2113	405.2113 Medical review board.
42:2.0.1.2.6.14.33.7	SECTION 405.2114	405.2114 [Reserved]
42:2.0.1.2.6.14.33.8	SECTION 405.2131-405.2184	405.2131-405.2184 [Reserved]
42:2.0.1.2.6.15	SUBPART V	Subparts V-W [Reserved]
42:2.0.1.2.6.16	SUBPART X	Subpart X - Rural Health Clinic and Federally Qualified Health Center Services
42:2.0.1.2.6.16.33	SUBJGRP 33	Federally Qualified Health Center Services
42:2.0.1.2.6.16.33.1	SECTION 405.2400	405.2400 Basis.
42:2.0.1.2.6.16.33.2	SECTION 405.2401	405.2401 Scope and definitions.
42:2.0.1.2.6.16.33.3	SECTION 405.2402	405.2402 Rural health clinic basic requirements.
42:2.0.1.2.6.16.33.4	SECTION 405.2403	405.2403 Rural health clinic content and terms of the agreement with the Secretary.
42:2.0.1.2.6.16.33.5	SECTION 405.2404	405.2404 Termination of rural health clinic agreements.
42:2.0.1.2.6.16.33.6	SECTION 405.2410	405.2410 Application of Part B deductible and coinsurance.
42:2.0.1.2.6.16.33.7	SECTION 405.2411	405.2411 Scope of benefits.
42:2.0.1.2.6.16.33.8	SECTION 405.2412	405.2412 Physicians' services.
42:2.0.1.2.6.16.33.9	SECTION 405.2413	405.2413 Services and supplies incident to a physician's services.
42:2.0.1.2.6.16.33.10	SECTION 405.2414	405.2414 Nurse practitioner, physician assistant, and certified nurse midwife services.
42:2.0.1.2.6.16.33.11	SECTION 405.2415	405.2415 Incident to services and direct supervision.
42:2.0.1.2.6.16.33.12	SECTION 405.2416	405.2416 Visiting nurse services.
42:2.0.1.2.6.16.33.13	SECTION 405.2417	405.2417 Visiting nurse services: Determination of shortage of agencies.
42:2.0.1.2.6.16.33.14	SECTION 405.2430	405.2430 Basic requirements.
42:2.0.1.2.6.16.33.15	SECTION 405.2434	405.2434 Content and terms of the agreement.
42:2.0.1.2.6.16.33.16	SECTION 405.2436	405.2436 Termination of agreement.
42:2.0.1.2.6.16.33.17	SECTION 405.2440	405.2440 Conditions for reinstatement after termination by CMS.
42:2.0.1.2.6.16.33.18	SECTION 405.2442	405.2442 Notice to the public.
42:2.0.1.2.6.16.33.19	SECTION 405.2444	405.2444 Change of ownership.
42:2.0.1.2.6.16.33.20	SECTION 405.2446	405.2446 Scope of services.
42:2.0.1.2.6.16.33.21	SECTION 405.2448	405.2448 Preventive primary services.
42:2.0.1.2.6.16.33.22	SECTION 405.2449	405.2449 Preventive services.
42:2.0.1.2.6.16.33.23	SECTION 405.2450	405.2450 Clinical psychologist and clinical social worker services.
42:2.0.1.2.6.16.33.24	SECTION 405.2452	405.2452 Services and supplies incident to clinical psychologist and clinical social worker services.
42:2.0.1.2.6.16.34	SUBJGRP 34	Payment for Rural Health Clinic and Federally Qualified Health Center Services
42:2.0.1.2.6.16.34.25	SECTION 405.2460	405.2460 Applicability of general payment exclusions.
42:2.0.1.2.6.16.34.26	SECTION 405.2462	405.2462 Payment for RHC and FQHC services.
42:2.0.1.2.6.16.34.27	SECTION 405.2463	405.2463 What constitutes a visit.
42:2.0.1.2.6.16.34.28	SECTION 405.2464	405.2464 Payment rate.
42:2.0.1.2.6.16.34.29	SECTION 405.2466	405.2466 Annual reconciliation.
42:2.0.1.2.6.16.34.30	SECTION 405.2467	405.2467 Requirements of the FQHC PPS.
42:2.0.1.2.6.16.34.31	SECTION 405.2468	405.2468 Allowable costs.
42:2.0.1.2.6.16.34.32	SECTION 405.2469	405.2469 FQHC supplemental payments.
42:2.0.1.2.6.16.34.33	SECTION 405.2470	405.2470 Reports and maintenance of records.
42:2.0.1.2.6.16.34.34	SECTION 405.2472	405.2472 Beneficiary appeals.

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