|
Home Page > Executive Branch > Code of Federal Regulations > Electronic Code of Federal Regulations
e-CFR Data is current as of February 4, 2010
TITLE 42--Public Health
CHAPTER IV--CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES
SUBCHAPTER B--MEDICARE PROGRAM
PART 414--PAYMENT FOR PART B MEDICAL AND OTHER HEALTH SERVICES
Subpart A--GENERAL PROVISIONS
Subpart B--PHYSICIANS AND OTHER PRACTITIONERS
|
| Formula for computing fee schedule amounts. |
|
|
| Relative value units (RVUs). |
|
|
| Review, revision, and addition of RVUs for physician services. |
|
|
| Conversion factor update. |
|
|
| Determining payments for certain physicians' services furnished in facility settings. |
|
|
| Payment for services and supplies incident to a physician's service. |
|
|
| Payment for drugs incident to a physician's service. |
|
|
| Special rules for payment of care plan oversight. |
|
|
| Coding and ancillary policies. |
|
|
| Adjustment for first 4 years of practice. |
|
|
| Additional rules for payment of anesthesia services. |
|
|
| Limits on actual charges of nonparticipating suppliers. |
|
|
| Physician or other supplier billing for diagnostic tests performed or interpreted by a physician who does not share a practice with the billing physician or other supplier. |
|
|
| Payment for physician assistants' services. |
|
|
| Payment for certified nurse-midwives' services. |
|
|
| Payment for nurse practitioners' and clinical nurse specialists' services. |
|
|
| Payment of charges for physician services to patients in providers. |
|
|
| Payment for the services of CRNAs. |
|
|
| Payment for anesthesia services furnished by a teaching CRNA. |
|
|
| Fee schedule for clinical psychologist services. |
|
|
| Payment for outpatient diabetes self-management training. |
|
|
| Payment for medical nutrition therapy. |
|
|
| Payment for telehealth services. |
|
|
| Incentive payments for physician scarcity areas. |
|
|
| Incentive payments for Health Professional Shortage Areas. |
|
Subpart C--FEE SCHEDULES FOR PARENTERAL AND ENTERAL NUTRITION (PEN) NUTRIENTS, EQUIPMENT AND SUPPLIES
Subpart D--PAYMENT FOR DURABLE MEDICAL EQUIPMENT AND PROSTHETIC AND ORTHOTIC DEVICES
|
| Inexpensive or routinely purchased items. |
|
|
| Items requiring frequent and substantial servicing. |
|
|
| Oxygen and oxygen equipment. |
|
|
| Prosthetic and orthotic devices. |
|
|
| Other durable medical equipment--capped rental items. |
|
|
| Determining a period of continuous use. |
|
|
| Special payment rules for transcutaneous electrical nerve stimulators (TENS). |
|
Subpart E--DETERMINATION OF REASONABLE CHARGES UNDER THE ESRD PROGRAM
|
| Determination of reasonable charges for physician services furnished to renal dialysis patients. |
|
|
| Initial method of payment. |
|
|
| Monthly capitation payment method. |
|
|
| Payment for physician services to patients in training for self-dialysis and home dialysis. |
|
|
| Determination of reasonable charges for physician renal transplantation services. |
|
|
| Payment for home dialysis equipment, supplies, and support services. |
|
|
| Payment for EPO furnished to a home dialysis patient for use in the home. |
|
Subpart F--COMPETITIVE BIDDING FOR CERTAIN DURABLE MEDICAL EQUIPMENT, PROSTHETICS, ORTHOTICS, AND SUPPLIES (DMEPOS)
|
| Implementation of programs. |
|
|
| Phased-in implementation of competitive bidding programs. |
|
|
| Submission of bids under a competitive bidding program. |
|
|
| Conditions for awarding contracts. |
|
|
| Determination of competitive bidding payment amounts. |
|
|
| Opportunity for networks. |
|
|
| Physician or treating practitioner authorization and consideration of clinical efficiency and value of items. |
|
|
| Administrative or judicial review. |
|
|
| Adjustments to competitively bid payment amounts to reflect changes in the HCPCS. |
|
Subpart G--PAYMENT FOR NEW CLINICAL DIAGNOSTIC LABORATORY TESTS
|
| Procedures for public consultation for payment for a new clinical diagnostic laboratory test. |
|
|
| Payment for a new clinical diagnostic laboratory test. |
|
|
| Reconsideration of basis for and amount of payment for a new clinical diagnostic laboratory test. |
|
|
| Laboratory date of service for clinical laboratory and pathology specimens. |
|
Subpart H--FEE SCHEDULE FOR AMBULANCE SERVICES
|
| Transition to the ambulance fee schedule. |
|
|
| Transition from regional to national ambulance fee schedule. |
|
|
| Publication of the ambulance fee schedule. |
|
Subpart I--PAYMENT FOR DRUGS AND BIOLOGICALS
Subpart J--SUBMISSION OF MANUFACTURER'S AVERAGE SALES PRICE DATA
|
| Penalties associated with the failure to submit timely and accurate ASP data. |
|
Subpart K--PAYMENT FOR DRUGS AND BIOLOGICALS UNDER PART B
|
| Average sales price as the basis for payment. |
|
|
| Competitive acquisition program as the basis for payment. |
|
|
| Competitive acquisition program. |
|
|
| Dispute resolution for vendors and beneficiaries. |
|
|
| Dispute resolution and process for suspension or termination of approved CAP contract and termination of physician participation under exigent circumstances. |
|
|
| Compendia for determination of medically-accepted indications for off-label uses of drugs and biologicals in an anti-cancer chemotherapeutic regimen. |
|
Subpart L--SUPPLYING AND DISPENSING FEES
Subpart M--PAYMENT FOR COMPREHENSIVE OUTPATIENT REHABILITATION FACILITY (CORF) SERVICES
|
| Payment for Comprehensive Outpatient Rehabilitation Facility (CORF) services. |
|
|
