Part 424 — Conditions for Medicare Payment
Subpart A — General Provisions
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.
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.
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.
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.
- § 424.67— Enrollment requirements for opioid treatment programs (OTP).
- § 424.68— Enrollment requirements for home infusion therapy suppliers.
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.
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.
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.
Subpart I — Requirements for Medicare Diabetes Prevention Program Suppliers and Beneficiary Engagement Incentives Under the Medicare Diabetes Prevention Program Expanded Model
Subpart M — Replacement and Reclamation of Medicare Payments
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— Disclosure of affiliations.
- § 424.520— Effective date of Medicare billing privileges.
- § 424.521— Request for payment by certain provider and supplier types.
- § 424.522— Additional effective dates.
- § 424.525— Rejection of a provider's or supplier's application for Medicare enrollment.
- § 424.526— Return of a provider's or supplier's enrollment application.
- § 424.527— Provisional period of enhanced oversight.
- § 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.
- § 424.541— Stay of enrollment.
- § 424.542— Prohibition on ordering, certifying, referring, or prescribing based on felony conviction.
- § 424.545— Provider and supplier appeal rights.
- § 424.546— Deactivation rebuttals.
- § 424.547— Deactivation based on ordering, certifying, or referring services and items.
- § 424.550— Prohibitions on the sale or transfer of billing privileges.
- § 424.551— DMEPOS supplier changes in majority ownership.
- § 424.555— Payment liability.
- § 424.565— Overpayment.
- § 424.570— Moratoria on newly enrolling Medicare providers and suppliers.
- § 424.575— Rural emergency hospitals.