Subpart A - General Exclusions and Exclusion of Particular Services

§ 411.1 - Basis and scope.

§ 411.2 - Conclusive effect of QIO determinations on payment of claims.

§ 411.4 - Services for which neither the beneficiary nor any other person is legally obligated to pay.

§ 411.6 - Services furnished by a Federal provider of services or other Federal agency.

§ 411.7 - Services that must be furnished at public expense under a Federal law or Federal Government contract.

§ 411.8 - Services paid for by a Government entity.

§ 411.9 - Services furnished outside the United States.

§ 411.10 - Services required as a result of war.

§ 411.12 - Charges imposed by an immediate relative or member of the beneficiary's household.

§ 411.15 - Particular services excluded from coverage.

Subpart B - Insurance Coverage That Limits Medicare Payment: General Provisions

§ 411.20 - Basis and scope.

§ 411.21 - Definitions.

§ 411.22 - Reimbursement obligations of primary payers and entities that received payment from primary payers.

§ 411.23 - Beneficiary's cooperation.

§ 411.24 - Recovery of conditional payments.

§ 411.25 - Primary payer's notice of primary payment responsibility.

§ 411.26 - Subrogation and right to intervene.

§ 411.28 - Waiver of recovery and compromise of claims.

§ 411.30 - Effect of primary payment on benefit utilization and deductibles.

§ 411.31 - Authority to bill primary payers for full charges.

§ 411.32 - Basis for Medicare secondary payments.

§ 411.33 - Amount of Medicare secondary payment.

§ 411.35 - Limitations on charges to a beneficiary or other party when a workers' compensation plan, a no-fault insurer, or an employer group health plan is primary payer.

§ 411.37 - Amount of Medicare recovery when a primary payment is made as a result of a judgment or settlement.

§ 411.39 - Automobile and liability insurance (including self-insurance), no-fault insurance, and workers' compensation: Final conditional payment amounts via Web portal.

Subpart C - Limitations on Medicare Payment for Services Covered Under Workers' Compensation

§ 411.40 - General provisions.

§ 411.43 - Beneficiary's responsibility with respect to workers' compensation.

§ 411.45 - Basis for conditional Medicare payment in workers' compensation cases.

§ 411.46 - Lump-sum payments.

§ 411.47 - Apportionment of a lump-sum compromise settlement of a workers' compensation claim.

Subpart D - Limitations on Medicare Payment for Services Covered Under Liability or No-Fault Insurance

§ 411.50 - General provisions.

§ 411.51 - Beneficiary's responsibility with respect to no-fault insurance.

§ 411.52 - Basis for conditional Medicare payment in liability cases.

§ 411.53 - Basis for conditional Medicare payment in no-fault cases.

§ 411.54 - Limitation on charges when a beneficiary has received a liability insurance payment or has a claim pending against a liability insurer.

Subpart E - Limitations on Payment for Services Covered Under Group Health Plans: General Provisions

§ 411.100 - Basis and scope.

§ 411.101 - Definitions.

§ 411.102 - Basic prohibitions and requirements.

§ 411.103 - Prohibition against financial and other incentives.

§ 411.104 - Current employment status.

§ 411.106 - Aggregation rules.

§ 411.108 - Taking into account entitlement to Medicare.

§ 411.110 - Basis for determination of nonconformance.

§ 411.112 - Documentation of conformance.

§ 411.114 - Determination of nonconformance.

§ 411.115 - Notice of determination of nonconformance.

§ 411.120 - Appeals.

§ 411.121 - Hearing procedures.

§ 411.122 - Hearing officer's decision.

§ 411.124 - Administrator's review of hearing decision.

§ 411.126 - Reopening of determinations and decisions.

§ 411.130 - Referral to Internal Revenue Service (IRS).

Subpart F - Special Rules: Individuals Eligible or Entitled on the Basis of ESRD, Who Are Also Covered Under Group Health Plans

§ 411.160 - Scope.

§ 411.161 - Prohibition against taking into account Medicare eligibility or entitlement or differentiating benefits.

§ 411.162 - Medicare benefits secondary to group health plan benefits.

§ 411.163 - Coordination of benefits: Dual entitlement situations.

§ 411.165 - Basis for conditional Medicare payments.

Subpart G - Special Rules: Aged Beneficiaries and Spouses Who Are Also Covered Under Group Health Plans

§ 411.170 - General provisions.

§ 411.172 - Medicare benefits secondary to group health plan benefits.

§ 411.175 - Basis for Medicare primary payments.

Subpart H - Special Rules: Disabled Beneficiaries Who Are Also Covered Under Large Group Health Plans

§ 411.200 - Basis.

§ 411.201 - Definitions.

§ 411.204 - Medicare benefits secondary to LGHP benefits.

§ 411.206 - Basis for Medicare primary payments and limits on secondary payments.

Subpart I - XXX

Subpart J - Financial Relationships Between Physicians and Entities Furnishing Designated Health Services

§ 411.350 - Scope of subpart.

§ 411.351 - Definitions.

§ 411.352 - Group practice.

§ 411.353 - Prohibition on certain referrals by physicians and limitations on billing.

§ 411.354 - Financial relationship, compensation, and ownership or investment interest.

§ 411.355 - General exceptions to the referral prohibition related to both ownership/investment and compensation.

§ 411.356 - Exceptions to the referral prohibition related to ownership or investment interests.

§ 411.357 - Exceptions to the referral prohibition related to compensation arrangements.

§ 411.360 - Group practice attestation.

§ 411.361 - Reporting requirements.

§ 411.362 - Additional requirements concerning physician ownership and investment in hospitals.

§ 411.363 - Process for requesting an exception from the prohibition on facility expansion.

§ 411.370 - Advisory opinions relating to physician referrals.

§ 411.372 - Procedure for submitting a request.

§ 411.373 - Certification.

§ 411.375 - Fees for the cost of advisory opinions.

§ 411.377 - Expert opinions from outside sources.

§ 411.378 - Withdrawing a request.

§ 411.379 - When CMS accepts a request.

§ 411.380 - When CMS issues a formal advisory opinion.

§ 411.382 - CMS' right to rescind advisory opinions.

§ 411.384 - Disclosing advisory opinions and supporting information.

§ 411.386 - CMS's advisory opinions as exclusive.

§ 411.387 - Effect of an advisory opinion.

§ 411.388 - When advisory opinions are not admissible evidence.

§ 411.389 - Range of the advisory opinion.

Subpart K - Payment for Certain Excluded Services

§ 411.400 - Payment for custodial care and services not reasonable and necessary.

§ 411.402 - Indemnification of beneficiary.

§ 411.404 - Criteria for determining that a beneficiary knew that services were excluded from coverage as custodial care or as not reasonable and necessary.

§ 411.406 - Criteria for determining that a provider, practitioner, or supplier knew that services were excluded from coverage as custodial care or as not reasonable and necessary.

§ 411.408 - Refunds of amounts collected for physician services not reasonable and necessary, payment not accepted on an assignment-related basis.