§419.21. Hospital services subject to the outpatient prospective payment system.
42 C.F.R. § 419.21
Except for services described in § 419.22, effective for services furnished on or after July 1, 2000, payment is made under the hospital outpatient prospective payment system for the following:
Medicare Part B services furnished to hospital outpatients designated by the Secretary under this part.
Services designated by the Secretary that are covered under Medicare Part B when furnished to hospital inpatients who are either not entitled to benefits under Part A or who have exhausted their Part A benefits but are entitled to benefits under Part B of the program.
Partial hospitalization services and intensive outpatient services furnished by community mental health centers (CMHCs).
The following medical and other health services furnished by a home health agency (HHA) to patients who are not under an HHA plan or treatment or by a hospice program furnishing services to patients outside the hospice benefit:
Antigens.
Splints and casts.
Hepatitis B vaccine.
Effective January 1, 2005 through December 31, 2008, an initial preventive physical examination, as defined in § 410.16 of this chapter, if the examination is performed no later than 6 months after the individual's initial Part B coverage date that begins on or after January 1, 2005.
Effective January 1, 2009, an initial preventive physical examination, as defined in § 410.16 of this chapter, if the examination is performed no later than 12 months after the date of the individual's initial enrollment in Part B.
Notes, amendments, and revision history
Amendments
[65 FR 18542, Apr. 7, 2000, as amended at 67 FR 66813, Nov. 1, 2002; 69 FR 65863, Nov. 15, 2004; 71 FR 68227, Nov. 24, 2006: 75 FR 72265, Nov. 24, 2010; 88 FR 82180, Nov. 22, 2023]
Authority
Authority: 42 U.S.C. 1302, 1395l(t), and 1395hh.
Source
Source: 65 FR 18542, Apr. 7, 2000, unless otherwise noted.
Amendments
[65 FR 18542, Apr. 7, 2000, as amended at 67 FR 66813, Nov. 1, 2002; 69 FR 65863, Nov. 15, 2004; 71 FR 68227, Nov. 24, 2006: 75 FR 72265, Nov. 24, 2010; 88 FR 82180, Nov. 22, 2023]