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Code of Federal Regulations (Last Updated: November 8, 2024) |
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Title 42 - Public Health |
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Chapter IV - Centers for Medicare & Medicaid Services, Department of Health and Human Services |
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SubChapter B - Medicare Program |
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Part 424 - Conditions for Medicare Payment |
| 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. |
| § 424.45 - What constitutes a claim for purposes of meeting the time limits. |
| 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. |
| § 424.59 - Requirements for Medicare diabetes prevention program suppliers. |
| 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 - xxx |
| § 424.68 - xxx |
| 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 I--L - XXX |
| Subparts J--L - XXX |
| 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 - XXX |
| 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 - xxx |
| § 424.520 - Effective date of Medicare billing privileges. |
| § 424.521 - Request for payment by certain provider and supplier types. |
| § 424.522 - xxx |
| § 424.525 - Rejection of a provider's or supplier's application for Medicare enrollment. |
| § 424.526 - xxx |
| § 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 - xxx |
| § 424.550 - Prohibitions on the sale or transfer of billing privileges. |
| § 424.555 - Payment liability. |
| § 424.565 - Overpayment. |
| § 424.570 - Moratoria on newly enrolling Medicare providers and suppliers. |
| § 424.575 - Rural emergency hospitals. |