---
kind: "range"
citation: "42 C.F.R. §§ 409.21–409.26"
title: "42"
from: "409.21"
to: "409.26"
count: 6
url: "https://uscodex.org/cfr/42/409.21..409.26"
---

# §409.21. Nursing care.

- (a) **Basic rule.** Medicare pays for nursing care as posthospital SNF care when provided by or under the supervision of a registered professional nurse.
- (b) **Exception.** Medicare does not pay for the services of a private duty nurse or attendant. An individual is not considered to be a private duty nurse or attendant if he or she is an SNF employee at the time the services are furnished.

# §409.22. Bed and board.

- (a) **Semiprivate and ward accommodations.** Except for applicable deductible and coinsurance amounts Medicare Part A pays in full for semiprivate (2 to 4 beds), or ward (5 or more beds) accommodations.
- (b) **Private accommodations—**
  - (1) **Conditions for payment in full.** Except for applicable coinsurance amounts, Medicare pays in full for a private room if—
    - (i) The patient's condition requires him to be isolated;
    - (ii) The SNF has no semiprivate or ward accommodations; or
    - (iii) The SNF semiprivate and ward accommodations are fully occupied by other patients, were so occupied at the time the patient was admitted to the SNF for treatment of a condition that required immediate inpatient SNF care, and have been so occupied during the interval.
  - (2) **Period of payment.** In the situations specified in [paragraph (b)(1)](#b-1) (i) and (iii) of this section. Medicare pays for a private room until the patient's condition no longer requires isolation or until semiprivate or ward accommodations are available.
  - (3) **Conditions for patient's liability.** The facility may charge the patient the difference between its customary charge for the private room furnished and its most prevalent charge for a semiprivate room if:
    - (i) None of the conditions of [paragraph (b)(1)](#b-1) of this section is met, and
    - (ii) The private room was requested by the patient or a member of the family who, at the time of request was informed what the charge would be.

# §409.23. Physical therapy, occupational therapy, and speech-language pathology services.


Medicare pays for physical therapy, occupational therapy, or speech-language pathology services as posthospital SNF care if they are furnished—

- (a) By (or under arrangements made by) the facility and billed by (or through) the facility;
- (b) By qualified physical therapists, physical therapist assistants, occupational therapists, occupational therapy assistants, or speech-language pathologists as defined in [part 484](/cfr/42/part484.md) of this chapter; and
- (c) In accordance with a plan that meets the requirements of [§ 409.17(b) through (d)](/cfr/42/409.17.md?p=b..d) of this part.

# §409.24. Medical social services.


Medicare pays for medical social services as posthospital SNF care, including—

- (a) Assessment of the social and emotional factors related to the beneficiary's illness, need for care, response to treatment, and adjustment to care in the facility;
- (b) Case work services to assist in resolving social or emotional problems that may have an adverse effect on the beneficiary's ability to respond to treatment; and
- (c) Assessment of the relationship of the beneficiary's medical and nursing requirements to his or her home situation, financial resources, and the community resources available upon discharge from facility care.

# §409.25. Drugs, biologicals, supplies, appliances, and equipment.

- (a) **Drugs and biologicals.** Except as specified in [paragraph (b)](#b) of this section, Medicare pays for drugs and biologicals as posthospital SNF care only if—
  - (1) They represent a cost to the facility;
  - (2) They are ordinarily furnished by the facility for the care and treatment of inpatients; and
  - (3) **They are furnished to an inpatient for use in the facility.**
- (b) **Exception.** Medicare pays for a limited supply of drugs for use outside the facility if it is medically necessary to facilitate the beneficiary's departure from the facility and required until he or she can obtain a continuing supply.
- (c) **Supplies, appliances, and equipment.** Except as specified in [paragraph (d)](#d) of this section, Medicare pays for supplies, appliances, and equipment as posthospital SNF care only if they are—
  - (1) Ordinarily furnished by the facility to inpatients; and
  - (2) **Furnished to inpatients for use in the facility.**
- (d) **Exception.** Medicare pays for items to be used after the individual leaves the facility if—
  - (1) The item is one that the beneficiary must continue to use after leaving, such as a leg brace; or
  - (2) The item is necessary to permit or facilitate the beneficiary's departure from the facility and is required until he or she can obtain a continuing supply, for example, sterile dressings.

# §409.26. Transfer agreement hospital services.

- (a) **Services furnished by an intern or a resident-in-training.** Medicare pays for medical services that are furnished by an intern or a resident-in-training (under a hospital teaching program approved in accordance with the provisions of [§ 409.15](/cfr/42/409.15.md)) as posthospital SNF care, if the intern or resident is in—
  - (1) A participating hospital with which the SNF has in effect an agreement under [§ 483.70(j)](/cfr/42/483.70.md?p=j) of this chapter for the transfer of patients and exchange of medical records; or
  - (2) A hospital that has a swing-bed approval, and is furnishing services to an SNF-level inpatient of that hospital.
- (b) **Other diagnostic or therapeutic services.** Medicare pays for other diagnostic or therapeutic services as posthospital SNF care if they are provided—
  - (1) By a participating hospital with which the SNF has in effect a transfer agreement as described in [paragraph (a)(1)](#a-1) of this section; or
  - (2) **By a hospital or a CAH that has a swing-bed approval, to its own SNF-level inpatient.**