---
kind: "section"
citation: "42 C.F.R. § 411.400"
title: "42"
number: "411.400"
heading: "Payment for custodial care and services not reasonable and necessary."
url: "https://uscodex.org/cfr/42/411.400"
---

# §411.400. Payment for custodial care and services not reasonable and necessary.

- (a) **Conditions for payment.** Notwithstanding the exclusions set forth in § [411.15 (g)](/cfr/42/411.15.md?p=g) and [(k)](/cfr/42/411.15.md?p=k). Medicare pays for “custodial care” and “services not reasonable and necessary” if the following conditions are met:
  - (1) The services were funished by a provider or by a practitioner or supplier that had accepted assignment of benefits for those services.
  - (2) Neither the beneficiary nor the provider, practitioner, or supplier knew, or could reasonably have been expected to know, that the services were excluded from coverage under § [411.15 (g)](/cfr/42/411.15.md?p=g) or [(k)](/cfr/42/411.15.md?p=k).
- (b) **Time limits on payment—**
  - (1) **Basic rule.** Except as provided in [paragraph (b)(2)](#b-2) of this section, payment may not be made for inpatient hospital care, posthospital SNF care, or home health services furnished after the earlier of the following:
    - (i) The day on which the beneficiary has been determined, under [§ 411.404](/cfr/42/411.404.md), to have knowledge, actual or imputed, that the services were excluded from coverage by reason of [§ 411.15(g)](/cfr/42/411.15.md?p=g) or [§ 411.15(k)](/cfr/42/411.15.md?p=k).
    - (ii) The day on which the provider has been determined, under [§ 411.406](/cfr/42/411.406.md) to have knowledge, actual or imputed, that the services are excluded from coverage by reason of [§ 411.15(g)](/cfr/42/411.15.md?p=g) or [§ 411.15(k)](/cfr/42/411.15.md?p=k).
  - (2) **Exception.** Payment may be made for services furnished during the first day after the limit established in [paragraph (b)(1)](#b-1) of this section, if the QIO or the intermediary determines that the additional period of one day is necessary for planning post-discharge care. It the QIO or the intermediary determines that yet another day is necessary for planning post-discharge care, payment may be made for services furnished during the second day after the limit established in [paragraph (b)(1)](#b-1) of this section.

## Notes

### Authority

Authority: 42 U.S.C. 1302, 1395w-101 through 1395w-152, 1395hh, and 1395nn.

### Source

Source: 54 FR 41734, Oct. 11, 1989, unless otherwise noted.