---
kind: "section"
citation: "42 C.F.R. § 424.103"
title: "42"
number: "424.103"
heading: "Conditions for payment for emergency services."
url: "https://uscodex.org/cfr/42/424.103"
---

# §424.103. Conditions for payment for emergency services.


Medicare pays for emergency services furnished to a beneficiary by a nonparticipating hospital or under arrangements made by such a hospital if the conditions of this section are met.

- (a) **General requirements.**
  - (1) The services are of the type that Medicare would pay for if they were furnished by a participating hospital.
  - (2) The hospital has in effect an election to claim payment for all emergency services furnished in a calendar year in accordance with [§ 424.104](/cfr/42/424.104.md).
  - (3) **The need for emergency services arose while the beneficiary was not an inpatient in a hospital.**
  - (4) In the case of inpatient hospital services, the services are furnished during a period in which the beneficiary could not be safely discharged or transferred to a participating hospital or other institution.
  - (5) The determination that the hospital was the most accessible hospital available and equipped to furnish the services is made in accordance with [§ 424.106](/cfr/42/424.106.md).
- (b) **Medical information requirements.** A physician (or, if appropriate, the hospital) submits medical information that—
  - (1) Describes the nature of the emergency and specifies why it required that the beneficiary be treated in the most accessible hospital;
  - (2) Establishes that all the conditions in [paragraph (a)](#a) of this section are met; and
  - (3) Indicates when the emergency ended, which, for inpatient hospital services, is the earliest date on which the beneficiary could be safely discharged or transferred to a participating hospital or other institution.

## Notes

### Authority

Authority: 42 U.S.C. 1302 and 1395hh.

### Source

Source: 53 FR 6634, Mar. 2, 1988, unless otherwise noted.