Title 42

PART 419

Part 419 - Prospective Payment System For Hospital Outpatient Department Services

PART 419 - PROSPECTIVE PAYMENT SYSTEM FOR HOSPITAL OUTPATIENT DEPARTMENT SERVICES Authority:42 U.S.C. 1302, 1395l(t), and 1395hh. Source:65 FR 18542, Apr. 7, 2000, unless otherwise noted.

42:3.0.1.1.6.1SUBPART A
Subpart A - General Provisions
42:3.0.1.1.6.1.9.1SECTION 419.1
   419.1 Basis and scope.
42:3.0.1.1.6.1.9.2SECTION 419.2
   419.2 Basis of payment.
42:3.0.1.1.6.2SUBPART B
Subpart B - Categories of Hospitals and Services Subject to and Excluded From the Hospital Outpatient Prospective Payment System
42:3.0.1.1.6.2.9.1SECTION 419.20
   419.20 Hospitals subject to the hospital outpatient prospective payment system.
42:3.0.1.1.6.2.9.2SECTION 419.21
   419.21 Hospital services subject to the outpatient prospective payment system.
42:3.0.1.1.6.2.9.3SECTION 419.22
   419.22 Hospital services excluded from payment under the hospital outpatient prospective payment system.
42:3.0.1.1.6.3SUBPART C
Subpart C - Basic Methodology for Determining Prospective Payment Rates for Hospital Outpatient Services
42:3.0.1.1.6.3.9.1SECTION 419.30
   419.30 Base expenditure target for calendar year 1999.
42:3.0.1.1.6.3.9.2SECTION 419.31
   419.31 Ambulatory payment classification (APC) system and payment weights.
42:3.0.1.1.6.3.9.3SECTION 419.32
   419.32 Calculation of prospective payment rates for hospital outpatient services.
42:3.0.1.1.6.4SUBPART D
Subpart D - Payments to Hospitals
42:3.0.1.1.6.4.9.1SECTION 419.40
   419.40 Payment concepts.
42:3.0.1.1.6.4.9.2SECTION 419.41
   419.41 Calculation of national beneficiary copayment amounts and national Medicare program payment amounts.
42:3.0.1.1.6.4.9.3SECTION 419.42
   419.42 Hospital election to reduce coinsurance.
42:3.0.1.1.6.4.9.4SECTION 419.43
   419.43 Adjustments to national program payment and beneficiary copayment amounts.
42:3.0.1.1.6.4.9.5SECTION 419.44
   419.44 Payment reductions for procedures.
42:3.0.1.1.6.4.9.6SECTION 419.45
   419.45 Payment and copayment reduction for devices replaced without cost or when full or partial credit is received.
42:3.0.1.1.6.4.9.7SECTION 419.46
   419.46 Participation, data submission, and validation requirements under the Hospital Outpatient Quality Reporting (OQR) Program.
42:3.0.1.1.6.4.9.8SECTION 419.48
   419.48 Definition of excepted items and services.
42:3.0.1.1.6.5SUBPART E
Subpart E - Updates
42:3.0.1.1.6.5.9.1SECTION 419.50
   419.50 Annual review.
42:3.0.1.1.6.6SUBPART F
Subpart F - Limitations on Review
42:3.0.1.1.6.6.9.1SECTION 419.60
   419.60 Limitations on administrative and judicial review.
42:3.0.1.1.6.7SUBPART G
Subpart G - Transitional Pass-through Payments
42:3.0.1.1.6.7.9.1SECTION 419.62
   419.62 Transitional pass-through payments: General rules.
42:3.0.1.1.6.7.9.2SECTION 419.64
   419.64 Transitional pass-through payments: Drugs and biologicals.
42:3.0.1.1.6.7.9.3SECTION 419.66
   419.66 Transitional pass-through payments: Medical devices.
42:3.0.1.1.6.8SUBPART H
Subpart H - Transitional Corridors
42:3.0.1.1.6.8.9.1SECTION 419.70
   419.70 Transitional adjustments to limit decline in payments.
42:3.0.1.1.6.8.9.2SECTION 419.71
   419.71 Payment reduction for certain X-ray imaging services.
42:3.0.1.1.6.9SUBPART I
Subpart I - Prior Authorization for Outpatient Department Services
42:3.0.1.1.6.9.9.1SECTION 419.80
   419.80 Basis and scope of this subpart.
42:3.0.1.1.6.9.9.2SECTION 419.81
   419.81 Definitions.
42:3.0.1.1.6.9.9.3SECTION 419.82
   419.82 Prior authorization for certain covered hospital outpatient department services.
42:3.0.1.1.6.9.9.4SECTION 419.83
   419.83 List of hospital outpatient department services requiring prior authorization.
42:3.0.1.1.6.9.9.5SECTION 419.84-419.89
   419.84-419.89 [Reserved]