Part 419 - Prospective Payment Systems for Hospital Outpatient Department Services  


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.
§ 419.23 - xxx
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.
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 - xxx
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.