---
kind: "section"
citation: "42 C.F.R. § 417.838"
title: "42"
number: "417.838"
heading: "Organization determinations."
url: "https://uscodex.org/cfr/42/417.838"
---

# §417.838. Organization determinations.

- (a) **Actions that are organization determinations.** For purposes of [§§ 417.830 through 417.840](/cfr/42/417.830..417.840.md), 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.
- (b) **Actions that are not organization determinations.** The following are not organization determinations for purposes of [§§ 417.830 through 417.840](/cfr/42/417.830..417.840.md):
  - (1) A determination regarding services that were furnished by the HCPP, either directly or under arrangement, for which the enrollee has no further obligation for payment.
  - (2) **A determination regarding services that are not covered under the HCPP's agreement with CMS.**

## Notes

### Amendments

[59 FR 59943, Nov. 21, 1994]

### Source

Source: 50 FR 1375, Jan. 10, 1985, unless otherwise noted.

### Authority

Authority: 42 U.S.C. 1302 and 1395hh, and 300e, 300e-5, and 300e-9, and 31 U.S.C. 9701.

### Amendments

[59 FR 59943, Nov. 21, 1994]