Title 42

PART 410

Part 410 - Supplementary Medical Insurance (smi) Benefits

PART 410 - SUPPLEMENTARY MEDICAL INSURANCE (SMI) BENEFITS Authority:42 U.S.C. 1302, 1395m, 1395hh, 1395rr, and 1395ddd. Source:51 FR 41339, Nov. 14, 1986, unless otherwise noted. Editorial Note:Nomenclature changes to part 410 appear at 62 FR 46037, Aug. 29, 1997.

42:2.0.1.2.10.1SUBPART A
Subpart A - General Provisions
42:2.0.1.2.10.1.35.1SECTION 410.1
   410.1 Basis and scope.
42:2.0.1.2.10.1.35.2SECTION 410.2
   410.2 Definitions.
42:2.0.1.2.10.1.35.3SECTION 410.3
   410.3 Scope of benefits.
42:2.0.1.2.10.1.35.4SECTION 410.5
   410.5 Other applicable rules.
42:2.0.1.2.10.2SUBPART B
Subpart B - Medical and Other Health Services
42:2.0.1.2.10.2.35.1SECTION 410.10
   410.10 Medical and other health services: Included services.
42:2.0.1.2.10.2.35.2SECTION 410.12
   410.12 Medical and other health services: Basic conditions and limitations.
42:2.0.1.2.10.2.35.3SECTION 410.14
   410.14 Special requirements for services furnished outside the United States.
42:2.0.1.2.10.2.35.4SECTION 410.15
   410.15 Annual wellness visits providing Personalized Prevention Plan Services: Conditions for and limitations on coverage.
42:2.0.1.2.10.2.35.5SECTION 410.16
   410.16 Initial preventive physical examination: Conditions for and limitations on coverage.
42:2.0.1.2.10.2.35.6SECTION 410.17
   410.17 Cardiovascular disease screening tests.
42:2.0.1.2.10.2.35.7SECTION 410.18
   410.18 Diabetes screening tests.
42:2.0.1.2.10.2.35.8SECTION 410.19
   410.19 Ultrasound screening for abdominal aortic aneurysms: Condition for and limitation on coverage.
42:2.0.1.2.10.2.35.9SECTION 410.20
   410.20 Physicians' services.
42:2.0.1.2.10.2.35.10SECTION 410.21
   410.21 Limitations on services of a chiropractor.
42:2.0.1.2.10.2.35.11SECTION 410.22
   410.22 Limitations on services of an optometrist.
42:2.0.1.2.10.2.35.12SECTION 410.23
   410.23 Screening for glaucoma: Conditions for and limitations on coverage.
42:2.0.1.2.10.2.35.13SECTION 410.24
   410.24 Limitations on services of a doctor of dental surgery or dental medicine.
42:2.0.1.2.10.2.35.14SECTION 410.25
   410.25 Limitations on services of a podiatrist.
42:2.0.1.2.10.2.35.15SECTION 410.26
   410.26 Services and supplies incident to a physician's professional services: Conditions.
42:2.0.1.2.10.2.35.16SECTION 410.27
   410.27 Therapeutic outpatient hospital or CAH services and supplies incident to a physician's or nonphysician practitioner's service: Conditions.
42:2.0.1.2.10.2.35.17SECTION 410.28
   410.28 Hospital or CAH diagnostic services furnished to outpatients: Conditions.
42:2.0.1.2.10.2.35.18SECTION 410.29
   410.29 Limitations on drugs and biologicals.
42:2.0.1.2.10.2.35.19SECTION 410.30
   410.30 Prescription drugs used in immunosuppressive therapy.
42:2.0.1.2.10.2.35.20SECTION 410.31
   410.31 Bone mass measurement: Conditions for coverage and frequency standards.
42:2.0.1.2.10.2.35.21SECTION 410.32
   410.32 Diagnostic x-ray tests, diagnostic laboratory tests, and other diagnostic tests: Conditions.
42:2.0.1.2.10.2.35.22SECTION 410.33
   410.33 Independent diagnostic testing facility.
42:2.0.1.2.10.2.35.23SECTION 410.34
   410.34 Mammography services: Conditions for and limitations on coverage.
42:2.0.1.2.10.2.35.24SECTION 410.35
   410.35 X-ray therapy and other radiation therapy services: Scope.
42:2.0.1.2.10.2.35.25SECTION 410.36
   410.36 Medical supplies, appliances, and devices: Scope.
42:2.0.1.2.10.2.35.26SECTION 410.37
   410.37 Colorectal cancer screening tests: Conditions for and limitations on coverage.
42:2.0.1.2.10.2.35.27SECTION 410.38
   410.38 Durable medical equipment, prosthetics, orthotics and supplies (DMEPOS): Scope and conditions.
42:2.0.1.2.10.2.35.28SECTION 410.39
   410.39 Prostate cancer screening tests: Conditions for and limitations on coverage.
42:2.0.1.2.10.2.35.29SECTION 410.40
   410.40 Coverage of ambulance services.
42:2.0.1.2.10.2.35.30SECTION 410.41
   410.41 Requirements for ambulance providers and suppliers.
42:2.0.1.2.10.2.35.31SECTION 410.42
   410.42 Limitations on coverage of certain services furnished to hospital outpatients.
42:2.0.1.2.10.2.35.32SECTION 410.43
   410.43 Partial hospitalization services: Conditions and exclusions.
42:2.0.1.2.10.2.35.33SECTION 410.45
   410.45 Rural health clinic services: Scope and conditions.
42:2.0.1.2.10.2.35.34SECTION 410.46
   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.
42:2.0.1.2.10.2.35.35SECTION 410.47
   410.47 Pulmonary rehabilitation program: Conditions for coverage.
42:2.0.1.2.10.2.35.36SECTION 410.48
   410.48 Kidney disease education services.
42:2.0.1.2.10.2.35.37SECTION 410.49
   410.49 Cardiac rehabilitation program and intensive cardiac rehabilitation program: Conditions of coverage.
42:2.0.1.2.10.2.35.38SECTION 410.50
   410.50 Institutional dialysis services and supplies: Scope and conditions.
42:2.0.1.2.10.2.35.39SECTION 410.52
   410.52 Home dialysis services, supplies, and equipment: Scope and conditions.
42:2.0.1.2.10.2.35.40SECTION 410.55
   410.55 Services related to kidney donations: Conditions.
42:2.0.1.2.10.2.35.41SECTION 410.56
   410.56 Screening pelvic examinations.
42:2.0.1.2.10.2.35.42SECTION 410.57
   410.57 Pneumococcal vaccine and flu vaccine.
42:2.0.1.2.10.2.35.43SECTION 410.58
   410.58 Additional services to HMO and CMP enrollees.
42:2.0.1.2.10.2.35.44SECTION 410.59
   410.59 Outpatient occupational therapy services: Conditions.
42:2.0.1.2.10.2.35.45SECTION 410.60
   410.60 Outpatient physical therapy services: Conditions.
42:2.0.1.2.10.2.35.46SECTION 410.61
   410.61 Plan of treatment requirements for outpatient rehabilitation services.
42:2.0.1.2.10.2.35.47SECTION 410.62
   410.62 Outpatient speech-language pathology services: Conditions and exclusions.
42:2.0.1.2.10.2.35.48SECTION 410.63
   410.63 Hepatitis B vaccine and blood clotting factors: Conditions.
42:2.0.1.2.10.2.35.49SECTION 410.64
   410.64 Additional preventive services.
42:2.0.1.2.10.2.35.50SECTION 410.66
   410.66 Emergency outpatient services furnished by a nonparticipating hospital and services furnished in a foreign country.
42:2.0.1.2.10.2.35.51SECTION 410.67
   410.67 Medicare coverage and payment of Opioid use disorder treatment services furnished by Opioid treatment programs.
42:2.0.1.2.10.2.35.52SECTION 410.68
   410.68 Antigens: Scope and conditions.
42:2.0.1.2.10.2.35.53SECTION 410.69
   410.69 Services of a certified registered nurse anesthetist or an anesthesiologist's assistant: Basic rule and definitions.
42:2.0.1.2.10.2.35.54SECTION 410.71
   410.71 Clinical psychologist services and services and supplies incident to clinical psychologist services.
42:2.0.1.2.10.2.35.55SECTION 410.73
   410.73 Clinical social worker services.
42:2.0.1.2.10.2.35.56SECTION 410.74
   410.74 Physician assistants' services.
42:2.0.1.2.10.2.35.57SECTION 410.75
   410.75 Nurse practitioners' services.
42:2.0.1.2.10.2.35.58SECTION 410.76
   410.76 Clinical nurse specialists' services.
42:2.0.1.2.10.2.35.59SECTION 410.77
   410.77 Certified nurse-midwives' services: Qualifications and conditions.
42:2.0.1.2.10.2.35.60SECTION 410.78
   410.78 Telehealth services.
42:2.0.1.2.10.2.35.61SECTION 410.79
   410.79 Medicare Diabetes Prevention Program expanded model: Conditions of coverage.
42:2.0.1.2.10.3SUBPART C
Subpart C - Home Health Services Under SMI
42:2.0.1.2.10.3.35.1SECTION 410.80
   410.80 Applicable rules.
42:2.0.1.2.10.4SUBPART D
Subpart D - Comprehensive Outpatient Rehabilitation Facility (CORF) Services
42:2.0.1.2.10.4.35.1SECTION 410.100
   410.100 Included services.
42:2.0.1.2.10.4.35.2SECTION 410.102
   410.102 Excluded services.
42:2.0.1.2.10.4.35.3SECTION 410.105
   410.105 Requirements for coverage of CORF services.
42:2.0.1.2.10.5SUBPART E
Subpart E - Community Mental Health Centers (CMHCs) Providing Partial Hospitalization Services
42:2.0.1.2.10.5.35.1SECTION 410.110
   410.110 Requirements for coverage of partial hospitalization services by CMHCs.
42:2.0.1.2.10.6SUBPART F
Subpart F [Reserved]
42:2.0.1.2.10.7SUBPART G
Subpart G - Medical Nutrition Therapy
42:2.0.1.2.10.7.35.1SECTION 410.130
   410.130 Definitions.
42:2.0.1.2.10.7.35.2SECTION 410.132
   410.132 Medical nutrition therapy.
42:2.0.1.2.10.7.35.3SECTION 410.134
   410.134 Provider qualifications.
42:2.0.1.2.10.8SUBPART H
Subpart H - Outpatient Diabetes Self-Management Training and Diabetes Outcome Measurements
42:2.0.1.2.10.8.35.1SECTION 410.140
   410.140 Definitions.
42:2.0.1.2.10.8.35.2SECTION 410.141
   410.141 Outpatient diabetes self-management training.
42:2.0.1.2.10.8.35.3SECTION 410.142
   410.142 CMS process for approving national accreditation organizations.
42:2.0.1.2.10.8.35.4SECTION 410.143
   410.143 Requirements for approved accreditation organizations.
42:2.0.1.2.10.8.35.5SECTION 410.144
   410.144 Quality standards for deemed entities.
42:2.0.1.2.10.8.35.6SECTION 410.145
   410.145 Requirements for entities.
42:2.0.1.2.10.8.35.7SECTION 410.146
   410.146 Diabetes outcome measurements.
42:2.0.1.2.10.9SUBPART I
Subpart I - Payment of SMI Benefits
42:2.0.1.2.10.9.35.1SECTION 410.150
   410.150 To whom payment is made.
42:2.0.1.2.10.9.35.2SECTION 410.152
   410.152 Amounts of payment.
42:2.0.1.2.10.9.35.3SECTION 410.155
   410.155 Outpatient mental health treatment limitation.
42:2.0.1.2.10.9.35.4SECTION 410.160
   410.160 Part B annual deductible.
42:2.0.1.2.10.9.35.5SECTION 410.161
   410.161 Part B blood deductible.
42:2.0.1.2.10.9.35.6SECTION 410.163
   410.163 Payment for services furnished to kidney donors.
42:2.0.1.2.10.9.35.7SECTION 410.165
   410.165 Payment for rural health clinic services and ambulatory surgical center services: Conditions.
42:2.0.1.2.10.9.35.8SECTION 410.170
   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.
42:2.0.1.2.10.9.35.9SECTION 410.172
   410.172 Payment for partial hospitalization services in CMHCs: Conditions.
42:2.0.1.2.10.9.35.10SECTION 410.175
   410.175 Alien absent from the United States.