42 C.F.R. §§ 417.834–417.840

Actions that are organization determinations. For purposes of §§ 417.830 through 417.840, an organization determination is a refusal to furnish or arrange for services, or reimburse the party for services provided to the beneficiary, on the grounds that the services are not covered by Medicare.

Actions that are not organization determinations. The following are not organization determinations for purposes of §§ 417.830 through 417.840:

Organization determinations and fast-track appeals that affect its Medicare enrollees; and

Reconsiderations, hearings, Medicare Appeals Council review, and judicial review of the organization determinations and fast-track appeals specified in paragraph (a) of this section.