---
kind: "section"
citation: "42 C.F.R. § 405.900"
title: "42"
number: "405.900"
heading: "Basis and scope."
url: "https://uscodex.org/cfr/42/405.900"
---

# §405.900. Basis and scope.

- (a) **Statutory basis.** This subpart is based on the following provisions of the Act:
  - (1) **Section 1869(a) through (e) and (g) of the Act.**
  - (2) **Section 1862(b)(2)(B)(viii) of the Act.**
- (b) **Scope.** This subpart establishes the requirements for appeals of initial determinations for benefits under Part A or Part B of Medicare, including the following:
  - (1) **The initial determination of whether an individual is entitled to benefits under Part A or Part B.** (Regulations governing reconsiderations of these initial determinations are at [20 CFR](/cfr/20.md), [part 404](/cfr/42/part404.md), [subpart J](/cfr/42/subpartJ.md)).
  - (2) **The initial determination of the amount of benefits available to an individual under Part A or Part B.**
  - (3) Any other initial determination relating to a claim for benefits under Part A or Part B, including an initial determination made by a quality improvement organization under section 1154(a)(2) of the Act or by an entity under contract with the Secretary (other than a contract under section 1852 of the Act) to administer provisions of titles XVIII or XI of the Act.

## Notes

### Amendments

[70 FR 11472, Mar. 8, 2005, as amended at 80 FR 10617, Feb. 27, 2015]

### Source

Source: 70 FR 11472, Mar. 8, 2005, unless otherwise noted.

### Authority

Authority: 42 U.S.C. 263a, 405(a), 1302, 1320b-12, 1395x, 1395y(a), 1395ff, 1395hh, 1395kk, 1395rr, and 1395ww(k).

### Amendments

[70 FR 11472, Mar. 8, 2005, as amended at 80 FR 10617, Feb. 27, 2015]