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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 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. |