---
kind: "section"
citation: "42 C.F.R. § 410.42"
title: "42"
number: "410.42"
heading: "Limitations on coverage of certain services furnished to hospital outpatients."
url: "https://uscodex.org/cfr/42/410.42"
---

# §410.42. Limitations on coverage of certain services furnished to hospital outpatients.

- (a) **General rule.** Except as provided in [paragraph (b)](#b) of this section, Medicare Part B does not pay for any item or service that is furnished to a hospital outpatient (as defined in [§ 410.2](/cfr/42/410.2.md)) during an encounter (as defined in [§ 410.2](/cfr/42/410.2.md)) by an entity other than the hospital unless the hospital has an arrangement (as defined in [§ 409.3](/cfr/42/409.3.md) of this chapter) with that entity to furnish that particular service to its patients. As used in this paragraph, the term “hospital” includes a CAH.
- (b) **Exception.** The limitations stated in [paragraph (a)](#a) of this section do not apply to the following services:
  - (1) Physician services that meet the requirements of [§ 415.102(a)](/cfr/42/415.102.md?p=a) of this chapter for payment on a fee schedule basis.
  - (2) **Physician assistant services, as defined in section 1861(s)(2)(K)(i) of the Act.**
  - (3) Nurse practitioner and clinical nurse specialist services, as defined in [section 1861(s)(2)(K)(ii)](/cfr/42/1861.md?p=s-2-K-ii) of the Act.
  - (4) **Certified nurse mid-wife services, as defined in section 1861(gg) of the Act.**
  - (5) **Qualified psychologist services, as defined in section 1861(ii) of the Act.**
  - (6) Services of an anesthetist, as defined in [§ 410.69](/cfr/42/410.69.md).
  - (7) Services furnished to SNF residents as defined in [§ 411.15(p)](/cfr/42/411.15.md?p=p) of this chapter.

## Notes

### Amendments

[65 FR 18536, Apr. 7, 2000]

### Authority

Authority: 42 U.S.C. 1302, 1395m, 1395hh, 1395rr, and 1395ddd.

### Source

Source: 51 FR 41339, Nov. 14, 1986, unless otherwise noted.

### Amendments

[65 FR 18536, Apr. 7, 2000]