42 CFR Part 424
PART 424—CONDITIONS FOR MEDICARE PAYMENT
- PART 424—CONDITIONS FOR MEDICARE PAYMENT
- Chapter IV—Centers for Medicare & Medicaid Services, Department of Health and Human Services › Subchapter B—Medicare Program
- Subpart A—General Provisions
- § 424.1 Basis and scope.
- § 424.3 Definitions.
- § 424.5 Basic conditions.
- § 424.7 General limitations.
- 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
- § 424.200 Scope.
- § 424.205 Requirements for Medicare Diabetes Prevention Program suppliers.
- § 424.210 Beneficiary engagement incentives under the Medicare Diabetes Prevention Program expanded model.
- Subparts J-L [Reserved]
- Subpart M—Replacement and Reclamation of Medicare Payments
- § 424.350 Replacement of checks that are lost, stolen, defaced, mutilated, destroyed, or paid on forged endorsements.
- § 424.352 Intermediary and carrier checks that are lost, stolen, defaced, mutilated, destroyed or paid on forged endorsements.
- Subparts N-O [Reserved]
- 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.
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