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Title 42 Part 424

Title 42 → Chapter IV → Subchapter B → Part 424

Electronic Code of Federal Regulations e-CFR

Title 42 Part 424

Title 42Chapter IVSubchapter BPart 424


TITLE 42—Public Health

CHAPTER IV—CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED)

SUBCHAPTER B—MEDICARE PROGRAM (CONTINUED)

PART 424—CONDITIONS FOR MEDICARE PAYMENT

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Subpart A—GENERAL PROVISIONS

§424.1
Basis and scope.
§424.3
Definitions.
§424.5
Basic conditions.
§424.7
General limitations.
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Subpart B—CERTIFICATION AND PLAN REQUIREMENTS

§424.10
Purpose and scope.
§424.11
General procedures.
§424.13
Requirements for inpatient services of hospitals other than inpatient psychiatric facilities.
§424.14
Requirements for inpatient services of inpatient psychiatric facilities.
§424.15
Requirements for inpatient CAH services.
§424.16
Timing of certification for individual admitted to a hospital before entitlement to Medicare benefits.
§424.20
Requirements for posthospital SNF care.
§424.22
Requirements for home health services.
§424.24
Requirements for medical and other health services furnished by providers under Medicare Part B.
§424.27
Requirements for comprehensive outpatient rehabilitation facility (CORF) services.
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Subpart C—CLAIMS FOR PAYMENT

§424.30
Scope.
§424.32
Basic requirements for all claims.
§424.33
Additional requirements: Claims for services of providers and claims by suppliers and nonparticipating hospitals.
§424.34
Additional requirements: Beneficiary's claim for direct payment.
§424.36
Signature requirements.
§424.37
Evidence of authority to sign on behalf of the beneficiary.
§424.40
Request for payment effective for more than one claim.
§424.44
Time limits for filing claims.
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Subpart D—TO WHOM PAYMENT IS ORDINARILY MADE

§424.50
Scope.
§424.51
Payment to the provider.
§424.52
Payment to a nonparticipating hospital.
§424.53
Payment to the beneficiary.
§424.54
Payment to the beneficiary's legal guardian or representative payee.
§424.55
Payment to the supplier.
§424.56
Payment to a beneficiary and to a supplier.
§424.57
Special payment rules for items furnished by DMEPOS suppliers and issuance of DMEPOS supplier billing privileges.
§424.58
Accreditation.
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Subpart E—TO WHOM PAYMENT IS MADE IN SPECIAL SITUATIONS

§424.60
Scope.
§424.62
Payment after beneficiary's death: Bill has been paid.
§424.64
Payment after beneficiary's death: Bill has not been paid.
§424.66
Payment to entities that provide coverage complementary to Medicare Part B.
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Subpart F—LIMITATIONS ON ASSIGNMENT AND REASSIGNMENT OF CLAIMS

§424.70
Basis and scope.
§424.71
Definitions.
§424.73
Prohibition of assignment of claims by providers.
§424.74
Termination of provider agreement.
§424.80
Prohibition of reassignment of claims by suppliers.
§424.82
Revocation of right to receive assigned benefits.
§424.83
Hearings on revocation of right to receive assigned benefits.
§424.84
Final determination on revocation of right to receive assigned benefits.
§424.86
Prohibition of assignment of claims by beneficiaries.
§424.90
Court ordered assignments: Conditions and limitations.
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Subpart G—SPECIAL CONDITIONS: EMERGENCY SERVICES FURNISHED BY A NONPARTICIPATING HOSPITAL

§424.100
Scope.
§424.101
Definitions.
§424.102
Situations that do not constitute an emergency.
§424.103
Conditions for payment for emergency services.
§424.104
Election to claim payment for emergency services furnished during a calendar year.
§424.106
Criteria for determining whether the hospital was the most accessible.
§424.108
Payment to a hospital.
§424.109
Payment to the beneficiary.
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Subpart H—SPECIAL CONDITIONS: SERVICES FURNISHED IN A FOREIGN COUNTRY

§424.120
Scope.
§424.121
Scope of payments.
§424.122
Conditions for payment for emergency inpatient hospital services.
§424.123
Conditions for payment for nonemergency inpatient services furnished by a hospital closer to the individual's residence.
§424.124
Conditions for payment for physician services and ambulance services.
§424.126
Payment to the hospital.
§424.127
Payment to the beneficiary.
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Subpart I—REQUIREMENTS FOR MEDICARE DIABETES PREVENTION PROGRAM SUPPLIERS AND BENEFICIARY ENGAGEMENT INCENTIVES UNDER THE MEDICARE DIABETES PREVENTION PROGRAM EXPANDED MODEL

§424.200
Scope.
§424.205
Requirements for Medicare Diabetes Prevention Program suppliers.
§424.210
Beneficiary engagement incentives under the Medicare Diabetes Prevention Program expanded model.
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Subparts J-L [Reserved]

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Subpart M—REPLACEMENT AND RECLAMATION OF MEDICARE PAYMENTS

§424.350
Replacement of checks that are lost, stolen, defaced, mutilated, destroyed, or paid on forged endorsements.
§424.352
Intermediary and carrier checks that are lost, stolen, defaced, mutilated, destroyed or paid on forged endorsements.
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Subparts N-O [Reserved]

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Subpart P—REQUIREMENTS FOR ESTABLISHING AND MAINTAINING MEDICARE BILLING PRIVILEGES

§424.500
Scope.
§424.502
Definitions.
§424.505
Basic enrollment requirement.
§424.506
National Provider Identifier (NPI) on all enrollment applications and claims.
§424.507
Ordering covered items and services for Medicare beneficiaries.
§424.510
Requirements for enrolling in the Medicare program.
§424.514
Application fee.
§424.515
Requirements for reporting changes and updates to, and the periodic revalidation of Medicare enrollment information.
§424.516
Additional provider and supplier requirements for enrolling and maintaining active enrollment status in the Medicare program.
§424.517
Onsite review.
§424.518
Screening levels for Medicare providers and suppliers.
§424.519
xxx
§424.520
Effective date of Medicare billing privileges.
§424.521
Request for payment by physicians, non-physician practitioners, physician and non-physician organizations, and ambulance suppliers.
§424.525
Rejection of a provider or supplier's enrollment application for Medicare enrollment.
§424.530
Denial of enrollment in the Medicare program.
§424.535
Revocation of enrollment in the Medicare program.
§424.540
Deactivation of Medicare billing privileges.
§424.545
Provider and supplier appeal rights.
§424.550
Prohibitions on the sale or transfer of billing privileges.
§424.555
Payment liability.
§424.565
Overpayment.
§424.570
Moratoria on newly enrolling Medicare providers and suppliers.

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