---
kind: "section"
citation: "42 C.F.R. § 419.21"
title: "42"
number: "419.21"
heading: "Hospital services subject to the outpatient prospective payment system."
url: "https://uscodex.org/cfr/42/419.21"
---

# §419.21. Hospital services subject to the outpatient prospective payment system.


Except for services described in [§ 419.22](/cfr/42/419.22.md), effective for services furnished on or after July 1, 2000, payment is made under the hospital outpatient prospective payment system for the following:

- (a) Medicare Part B services furnished to hospital outpatients designated by the Secretary under this part.
- (b) 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.
- (c) Partial hospitalization services and intensive outpatient services furnished by community mental health centers (CMHCs).
- (d) 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:
  - (1) **Antigens.**
  - (2) **Splints and casts.**
  - (3) **Hepatitis B vaccine.**
- (e)
  - (1) Effective January 1, 2005 through December 31, 2008, an initial preventive physical examination, as defined in [§ 410.16](/cfr/42/410.16.md) 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.
  - (2) Effective January 1, 2009, an initial preventive physical examination, as defined in [§ 410.16](/cfr/42/410.16.md) 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

[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]