Justia :: 42 C.F.R. PART 414--PAYMENT FOR PART B MEDICAL AND OTHER HEALTH SERVICES

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42 C.F.R. PART 414--PAYMENT FOR PART B MEDICAL AND OTHER HEALTH SERVICES

TITLE 42--Public Health

CHAPTER IV--CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES

SUBCHAPTER B--MEDICARE PROGRAM

PART 414--PAYMENT FOR PART B MEDICAL AND OTHER HEALTH SERVICES

Subpart A--GENERAL PROVISIONS

Basis and scope.

Definitions.

Fee schedule areas.

Subpart B--PHYSICIANS AND OTHER PRACTITIONERS

Formula for computing fee schedule amounts.

Medicare payment basis.

Relative value units (RVUs).

Review, revision, and addition of RVUs for physician services.

Determining the GAF.

Conversion factors.

Conversion factor update.

Determining payments for certain physicians' services furnished in facility settings.

Payment for services and supplies incident to a physician's service.

Payment for drugs incident to a physician's service.

Special rules for payment of care plan oversight.

Coding and ancillary policies.

Adjustment for first 4 years of practice.

Transition rules.

Additional rules for payment of anesthesia services.

Limits on actual charges of nonparticipating suppliers.

Physician billing for purchased diagnostic tests.

Payment for physician assistants' services.

Payment for certified nurse-midwives' services.

Payment for nurse practitioners' and clinical nurse specialists' services.

Payment of charges for physician services to patients in providers.

Payment for the services of CRNAs.

Fee schedule for clinical psychologist services.

Payment for outpatient diabetes self-management training.

Payment for medical nutrition therapy.

Payment for telehealth services.

Incentive payments for physician scarcity areas.

Incentive payments for Health Professional Shortage Areas.

Subpart C--FEE SCHEDULES FOR PARENTERAL AND ENTERAL NUTRITION (PEN) NUTRIENTS, EQUIPMENT AND SUPPLIES

Purpose.

General payment rules.

PEN Items and Services.

Subpart D--PAYMENT FOR DURABLE MEDICAL EQUIPMENT AND PROSTHETIC AND ORTHOTIC DEVICES

Purpose.

Definitions.

General payment rules.

Inexpensive or routinely purchased items.

Items requiring frequent and substantial servicing.

Customized items.

Oxygen and oxygen equipment.

Prosthetic and orthotic devices.

Other durable medical equipment--capped rental items.

Determining a period of continuous use.

Special payment rules for transcutaneous electrical nerve stimulators (TENS).

Subpart E--DETERMINATION OF REASONABLE CHARGES UNDER THE ESRD PROGRAM

Scope of subpart.

Determination of reasonable charges for physician services furnished to renal dialysis patients.

Initial method of payment.

Monthly capitation payment method.

Payment for physician services to patients in training for self-dialysis and home dialysis.

Determination of reasonable charges for physician renal transplantation services.

Payment for home dialysis equipment, supplies, and support services.

Payment for EPO furnished to a home dialysis patient for use in the home.

Subparts F-G--[RESERVED]

Subpart H--FEE SCHEDULE FOR AMBULANCE SERVICES

Purpose.

Definitions.

Basis of payment.

Transition to the ambulance fee schedule.

Transition from regional to national ambulance fee schedule.

Publication of the ambulance fee schedule.

Limitation on review.

Subpart I--PAYMENT FOR DRUGS AND BIOLOGICALS

Purpose.

Definitions.

Basis of payment.

Subpart J--SUBMISSION OF MANUFACTURER'S AVERAGE SALES PRICE DATA

Purpose.

Definitions.

Basis of payment.

Penalties associated with the failure to submit timely and accurate ASP data.

Subpart K--PAYMENT FOR DRUGS AND BIOLOGICALS UNDER PART B

Basis and scope.

Definitions.

Average sales price as the basis for payment.

Competitive acquisition program as the basis for payment.

Competitive acquisition program.

Bidding process.

Conflicts of interest

Terms of contract.

Dispute resolution for vendors and beneficiaries.

Dispute resolution and process for suspension or termination of approved CAP contract.

Assignment.

Judicial review.

Subpart L--SUPPLYING AND DISPENSING FEES

Purpose.

Basis of payment.