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FEDERAL · 42 CFR

Part 424 — Conditions for Medicare Payment

99 sections · Title 42: Public Health

§ 424.1Basis and scope.
§ 424.3Definitions.
§ 424.5Basic conditions.
§ 424.7General limitations.
§ 424.10Purpose and scope.
§ 424.11General procedures.
§ 424.13Requirements for inpatient services of hospitals other than inpatient psychiatric facilities.
§ 424.14Requirements for inpatient services of inpatient psychiatric facilities.
§ 424.15Requirements for inpatient CAH services.
§ 424.16Timing of certification for individual admitted to a hospital before entitlement to Medicare benefits.
§ 424.20Requirements for posthospital SNF care.
§ 424.22Requirements for home health services.
§ 424.24Requirements for medical and other health services furnished by providers under Medicare Part B.
§ 424.27Requirements for comprehensive outpatient rehabilitation facility (CORF) services.
§ 424.30Scope.
§ 424.32Basic requirements for all claims.
§ 424.33Additional requirements: Claims for services of providers and claims by suppliers and nonparticipating hospitals.
§ 424.34Additional requirements: Beneficiary's claim for direct payment.
§ 424.36Signature requirements.
§ 424.37Evidence of authority to sign on behalf of the beneficiary.
§ 424.40Request for payment effective for more than one claim.
§ 424.44Time limits for filing claims.
§ 424.50Scope.
§ 424.51Payment to the provider.
§ 424.52Payment to a nonparticipating hospital.
§ 424.53Payment to the beneficiary.
§ 424.54Payment to the beneficiary's legal guardian or representative payee.
§ 424.55Payment to the supplier.
§ 424.56Payment to a beneficiary and to a supplier.
§ 424.57Special payment rules for items furnished by DMEPOS suppliers and issuance of DMEPOS supplier billing privileges.
§ 424.58Accreditation.
§ 424.60Scope.
§ 424.62Payment after beneficiary's death: Bill has been paid.
§ 424.64Payment after beneficiary's death: Bill has not been paid.
§ 424.66Payment to entities that provide coverage complementary to Medicare Part B.
§ 424.67Enrollment requirements for opioid treatment programs (OTP).
§ 424.68Enrollment requirements for home infusion therapy suppliers.
§ 424.70Basis and scope.
§ 424.71Definitions.
§ 424.73Prohibition of assignment of claims by providers.
§ 424.74Termination of provider agreement.
§ 424.80Prohibition of reassignment of claims by suppliers.
§ 424.82Revocation of right to receive assigned benefits.
§ 424.83Hearings on revocation of right to receive assigned benefits.
§ 424.84Final determination on revocation of right to receive assigned benefits.
§ 424.86Prohibition of assignment of claims by beneficiaries.
§ 424.90Court ordered assignments: Conditions and limitations.
§ 424.100Scope.
§ 424.101Definitions.
§ 424.102Situations that do not constitute an emergency.
§ 424.103Conditions for payment for emergency services.
§ 424.104Election to claim payment for emergency services furnished during a calendar year.
§ 424.106Criteria for determining whether the hospital was the most accessible.
§ 424.108Payment to a hospital.
§ 424.109Payment to the beneficiary.
§ 424.120Scope.
§ 424.121Scope of payments.
§ 424.122Conditions for payment for emergency inpatient hospital services.
§ 424.123Conditions for payment for nonemergency inpatient services furnished by a hospital closer to the individual's residence.
§ 424.124Conditions for payment for physician services and ambulance services.
§ 424.126Payment to the hospital.
§ 424.127Payment to the beneficiary.
§ 424.200Scope.
§ 424.205Requirements for Medicare Diabetes Prevention Program suppliers.
§ 424.210Beneficiary engagement incentives under the Medicare Diabetes Prevention Program expanded model.
§ 424.350Replacement of checks that are lost, stolen, defaced, mutilated, destroyed, or paid on forged endorsements.
§ 424.352Intermediary and carrier checks that are lost, stolen, defaced, mutilated, destroyed or paid on forged endorsements.
§ 424.500Scope.
§ 424.502Definitions.
§ 424.505Basic enrollment requirement.
§ 424.506National Provider Identifier (NPI) on all enrollment applications and claims.
§ 424.507Ordering covered items and services for Medicare beneficiaries.
§ 424.510Requirements for enrolling in the Medicare program.
§ 424.514Application fee.
§ 424.515Requirements for reporting changes and updates to, and the periodic revalidation of Medicare enrollment information.
§ 424.516Additional provider and supplier requirements for enrolling and maintaining active enrollment status in the Medicare program.
§ 424.517Onsite review.
§ 424.518Screening levels for Medicare providers and suppliers.
§ 424.519Disclosure of affiliations.
§ 424.520Effective date of Medicare billing privileges.
§ 424.521Request for payment by certain provider and supplier types.
§ 424.522Additional effective dates.
§ 424.525Rejection of a provider's or supplier's application for Medicare enrollment.
§ 424.526Return of a provider's or supplier's enrollment application.
§ 424.527Provisional period of enhanced oversight.
§ 424.530Denial of enrollment in the Medicare program.
§ 424.535Revocation of enrollment in the Medicare program.
§ 424.540Deactivation of Medicare billing privileges.
§ 424.541Stay of enrollment.
§ 424.542Prohibition on ordering, certifying, referring, or prescribing based on felony conviction.
§ 424.545Provider and supplier appeal rights.
§ 424.546Deactivation rebuttals.
§ 424.547Deactivation based on ordering, certifying, or referring services and items.
§ 424.550Prohibitions on the sale or transfer of billing privileges.
§ 424.551DMEPOS supplier changes in majority ownership.
§ 424.555Payment liability.
§ 424.565Overpayment.
§ 424.570Moratoria on newly enrolling Medicare providers and suppliers.
§ 424.575Rural emergency hospitals.