42 CFR Part 419
PART 419—PROSPECTIVE PAYMENT SYSTEMS FOR HOSPITAL OUTPATIENT DEPARTMENT SERVICES
- PART 419—PROSPECTIVE PAYMENT SYSTEMS FOR HOSPITAL OUTPATIENT DEPARTMENT SERVICES
- Chapter IV—Centers for Medicare & Medicaid Services, Department of Health and Human Services › Subchapter B—Medicare Program
- Subpart A—General Provisions
- § 419.1 Basis and scope.
- § 419.2 Basis of payment.
- Subpart B—Categories of Hospitals and Services Subject to and Excluded From the Hospital Outpatient Prospective Payment System
- § 419.20 Hospitals subject to the hospital outpatient prospective payment system.
- § 419.21 Hospital services subject to the outpatient prospective payment system.
- § 419.22 Hospital services excluded from payment under the hospital outpatient prospective payment system.
- Subpart C—Basic Methodology for Determining Prospective Payment Rates for Hospital Outpatient Services
- § 419.30 Base expenditure target for calendar year 1999.
- § 419.31 Ambulatory payment classification (APC) system and payment weights.
- § 419.32 Calculation of prospective payment rates for hospital outpatient services.
- Subpart D—Payments to Hospitals
- § 419.40 Payment concepts.
- § 419.41 Calculation of national beneficiary copayment amounts and national Medicare program payment amounts.
- § 419.42 Hospital election to reduce coinsurance.
- § 419.43 Adjustments to national program payment and beneficiary copayment amounts.
- § 419.44 Payment reductions for procedures.
- § 419.45 Payment and copayment reduction for devices replaced without cost or when full or partial credit is received.
- § 419.46 Requirements under the Hospital Outpatient Quality Reporting (OQR) Program.
- § 419.47 Coding and payment for Category B Investigational Device Exemption (IDE) studies.
- § 419.48 Definition of excepted items and services.
- § 419.49 Additional payment for technetium-99m (Tc-99m) derived from domestically produced molybdenum-99 (Mo-99).
- Subpart E—Updates
- § 419.50 Annual review.
- Subpart F—Limitations on Review
- § 419.60 Limitations on administrative and judicial review.
- Subpart G—Transitional Pass-through Payments
- § 419.62 Transitional pass-through payments: General rules.
- § 419.64 Transitional pass-through payments: Drugs and biologicals.
- § 419.66 Transitional pass-through payments: Medical devices.
- Subpart H—Transitional Corridors
- § 419.70 Transitional adjustments to limit decline in payments.
- § 419.71 Payment reduction for certain X-ray imaging services.
- Subpart I—Prior Authorization for Outpatient Department Services
- § 419.80 Basis and scope of this subpart.
- § 419.81 Definitions.
- § 419.82 Prior authorization for certain covered hospital outpatient department services.
- § 419.83 List of hospital outpatient department services requiring prior authorization.
- §§ 419.84-419.89 [Reserved]
- Subpart J—Payments to Rural Emergency Hospitals (REHs)
- § 419.90 Basis and scope of subpart.
- § 419.91 Definitions.
- § 419.92 Payment to rural emergency hospitals.
- § 419.93 Payment for an off-campus provider-based department of a rural emergency hospital.
- § 419.94 Preclusion of administrative and judicial review.
- § 419.95 Requirements under the Rural Emergency Hospital Quality Reporting (REHQR) Program.
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