Code of Federal Regulations (Last Updated: July 5, 2024) |
Title 42 - Public Health |
Chapter IV - Centers for Medicare & Medicaid Services, Department of Health and Human Services |
SubChapter B - Medicare Program |
Part 424 - Conditions for Medicare Payment |
Subpart P - Requirements for Establishing and Maintaining Medicare Billing Privileges |
§ 424.521 - Request for payment by certain provider and supplier types.
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§ 424.521 Request for payment by physicians, non-physician practitioners, physician and non-physician organizations, ambulance suppliers, opioid treatment programs, and home infusion therapy suppliers.
(a) Physicians, non-physician practitioners, physician and non-physician practitioner organizations, ambulance suppliers, opioid treatment programs, and home infusion therapy supplierscertain provider and supplier types.
(a) Request for payment by certain provider and supplier types.
physician, non-physician practitioner, physician or non-physician organization, ambulance supplier, opioid treatment program, or home infusion therapy supplier(1) The providers and suppliers identified in paragraph (a)(2) of this section may retrospectively bill for services when the
,provider or supplier has met all program requirements
2(including State licensure requirements), and services were provided at the enrolled practice location for up to -
1(
i) Thirty days prior to their effective date if circumstances precluded enrollment in advance of providing services to Medicare beneficiaries; or
(
ii) Ninety days prior to their effective date if a Presidentially-declared disaster under the Robert T. Stafford Disaster Relief and Emergency Assistance Act, 42 U.S.C. 5121-5206 (Stafford Act) precluded enrollment in advance of providing services to Medicare beneficiaries.
(2) The provider and supplier types to which paragraph (a)(1) of this section applies are as follows:
(i) Physicians.
(ii) Non-physician practitioners.
(iii) Physician organizations.
(iv) Non-physician practitioner organizations.
(v) Ambulance suppliers.
(vi) Opioid treatment programs.
(vii) Part B hospital departments.
(viii) Clinical Laboratory Improvement Amendment labs.
(ix) Intensive cardiac rehabilitation facilities.
(x) Mammography centers.
(xi) Mass immunizers/pharmacies.
(xii) Radiation therapy centers.
(xiii) Home infusion therapy suppliers.
(xiv) Physical therapists.
(xv) Occupational therapists.
(xvi) Speech language pathologists.
(b) [Reserved]
[79 FR 72531, Dec. 5, 2014, as amended at 84 FR 63203, Nov. 15, 2019; 85 FR 70355, Nov. 4, 2020; 86 FR 62419, Nov. 9, 2021]