Title 42

PART 405 SUBPART E

Subpart E - Criteria for Determining Reasonable Charges Authority:Secs. 1102 and 1871 of the Social Security Act (42 U.S.C. 1302 and 1395hh). Source:32 FR 12599, Aug. 31, 1967, unless otherwise noted. Redesignated at 42 FR 52826, Sept. 30, 1977.

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

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.

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