42 CFR §410.42
Verified against eCFR.gov as of June 20, 2026View official text on eCFR.gov ↗
- (a)General rule. Except as provided in paragraph (b) of this section, Medicare Part B does not pay for any item or service that is furnished to a hospital outpatient (as defined in § 410.2) during an encounter (as defined in § 410.2) by an entity other than the hospital unless the hospital has an arrangement (as defined in § 409.3 of this chapter) with that entity to furnish that particular service to its patients. As used in this paragraph, the term “hospital” includes a CAH.
- (b)Exception. The limitations stated in paragraph (a) of this section do not apply to the following services:
- (1)Physician services that meet the requirements of § 415.102(a) of this chapter for payment on a fee schedule basis.
- (2)Physician assistant services, as defined in section 1861(s)(2)(K)(i) of the Act.
- (3)Nurse practitioner and clinical nurse specialist services, as defined in section 1861(s)(2)(K)(ii) of the Act.
- (4)Certified nurse mid-wife services, as defined in section 1861(gg) of the Act.
- (5)Qualified psychologist services, as defined in section 1861(ii) of the Act.
- (6)Services of an anesthetist, as defined in § 410.69.
- (7)Services furnished to SNF residents as defined in § 411.15(p) of this chapter.