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.