StacksVerified U.S. regulatory reference

42 CFR §411.45

Verified against eCFR.gov as of June 20, 2026View official text on eCFR.gov ↗
  1. (a)A conditional Medicare payment may be made under either of the following circumstances:
    1. (1)The beneficiary has filed a proper claim for workers' compensation benefits, but the intermediary or carrier determines that the workers' compensation carrier will not pay promptly. This includes cases in which a workers' compensation carrier has denied a claim.
    2. (2)The beneficiary, because of physical or mental incapacity, failed to file a proper claim.
  2. (b)Any conditional payment that CMS makes is conditioned on reimbursement to CMS in accordance with subpart B of this part.