Title 42--Public Health
CHAPTER IV--CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES PART 411--EXCLUSIONS FROM MEDICARE AND LIMITATIONS ON MEDICARE PAYMENT
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411.1 |
Basis and scope. |
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411.2 |
Conclusive effect of QIO determinations on payment of claims. |
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411.4 |
Services for which neither the beneficiary nor any other person is legally obligated to pay. |
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411.6 |
Services furnished by a Federal provider of services or other Federal agency. |
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411.7 |
Services that must be furnished at public expense under a Federal law or Federal Government contract. |
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411.8 |
Services paid for by a Government entity. |
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411.9 |
Services furnished outside the United States. |
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411.10 |
Services required as a result of war. |
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411.12 |
Charges imposed by an immediate relative or member of the beneficiary's household. |
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411.15 |
Particular services excluded from coverage. |
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411.20 |
Basis and scope. |
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411.21 |
Definitions. |
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411.22 |
Reimbursement obligations of primary payers and entities that received payment from primary payers. |
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411.23 |
Beneficiary's cooperation. |
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411.24 |
Recovery of conditional payments. |
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411.25 |
Primary payer's notice of primary payment responsibility. |
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411.26 |
Subrogation and right to intervene. |
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411.28 |
Waiver of recovery and compromise of claims. |
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411.30 |
Effect of primary payment on benefit utilization and deductibles. |
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411.31 |
Authority to bill primary payers for full charges. |
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411.32 |
Basis for Medicare secondary payments. |
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411.33 |
Amount of Medicare secondary payment. |
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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. |
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411.37 |
Amount of Medicare recovery when a primary payment is made as a result of a judgment or settlement. |
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411.40 |
General provisions. |
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411.43 |
Beneficiary's responsibility with respect to workers' compensation. |
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411.45 |
Basis for conditional Medicare payment in workers' compensation cases. |
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411.46 |
Lump-sum payments. |
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411.47 |
Apportionment of a lump-sum compromise settlement of a workers' compensation claim. |
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411.50 |
General provisions. |
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411.51 |
Beneficiary's responsibility with respect to no-fault insurance. |
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411.52 |
Basis for conditional Medicare payment in liability cases. |
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411.53 |
Basis for conditional Medicare payment in no-fault cases. |
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411.54 |
Limitation on charges when a beneficiary has received a liability insurance payment or has a claim pending against a liability insurer. |
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411.100 |
Basis and scope. |
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411.101 |
Definitions. |
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411.102 |
Basic prohibitions and requirements. |
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411.103 |
Prohibition against financial and other incentives. |
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411.104 |
Current employment status. |
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411.106 |
Aggregation rules. |
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411.108 |
Taking into account entitlement to Medicare. |
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411.110 |
Basis for determination of nonconformance. |
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411.112 |
Documentation of conformance. |
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411.114 |
Determination of nonconformance. |
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411.115 |
Notice of determination of nonconformance. |
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411.120 |
Appeals. |
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411.121 |
Hearing procedures. |
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411.122 |
Hearing officer's decision. |
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411.124 |
Administrator's review of hearing decision. |
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411.126 |
Reopening of determinations and decisions. |
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411.130 |
Referral to Internal Revenue Service (IRS). |
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411.160 |
Scope. |
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411.161 |
Prohibition against taking into account Medicare eligibility or entitlement or differentiating benefits. |
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411.162 |
Medicare benefits secondary to group health plan benefits. |
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411.163 |
Coordination of benefits: Dual entitlement situations. |
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411.165 |
Basis for conditional Medicare payments. |
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411.170 |
General provisions. |
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411.172 |
Medicare benefits secondary to group health plan benefits. |
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411.175 |
Basis for Medicare primary payments. |
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411.200 |
Basis. |
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411.201 |
Definitions. |
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411.204 |
Medicare benefits secondary to LGHP benefits. |
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411.206 |
Basis for Medicare primary payments and limits on secondary payments. |
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411.350 |
Scope of subpart. |
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411.351 |
Definitions. |
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411.351 |
Definitions. |
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411.352 |
Group practice. |
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411.353 |
Prohibition on certain referrals by physicians and limitations on billing. |
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411.354 |
Financial relationship, compensation, and ownership or investment interest. |
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411.355 |
General exceptions to the referral prohibition related to both ownership/investment and compensation. |
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411.356 |
Exceptions to the referral prohibition related to ownership or investment interests. |
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411.357 |
Exceptions to the referral prohibition related to compensation arrangements. |
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411.357 |
Exceptions to the referral prohibition related to compensation arrangements. |
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411.361 |
Reporting requirements. |
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411.370 |
Advisory opinions relating to physician referrals. |
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411.372 |
Procedure for submitting a request. |
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411.373 |
Certification. |
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411.375 |
Fees for the cost of advisory opinions. |
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411.377 |
Expert opinions from outside sources. |
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411.378 |
Withdrawing a request. |
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411.379 |
When CMS accepts a request. |
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411.380 |
When CMS issues a formal advisory opinion. |
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411.382 |
CMS's right to rescind advisory opinions. |
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411.384 |
Disclosing advisory opinions and supporting information. |
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411.386 |
CMS's advisory opinions as exclusive. |
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411.387 |
Parties affected by advisory opinions. |
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411.388 |
When advisory opinions are not admissible evidence. |
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411.389 |
Range of the advisory opinion. |
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411.400 |
Payment for custodial care and services not reasonable and necessary. |
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411.402 |
Indemnification of beneficiary. |
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411.404 |
Criteria for determining that a beneficiary knew that services were excluded from coverage as custodial care or as not reasonable and necessary. |
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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. |
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411.408 |
Refunds of amounts collected for physician services not reasonable and necessary, payment not accepted on an assignment-related basis. |