---
kind: "section"
citation: "42 C.F.R. § 424.5"
title: "42"
number: "424.5"
heading: "Basic conditions."
url: "https://uscodex.org/cfr/42/424.5"
---

# §424.5. Basic conditions.

- (a) As a basis for Medicare payment, the following conditions must be met:
  - (1) **Types of services.** The services must be—
    - (i) Covered services, as specified in [part 409](/cfr/42/part409.md) or [part 410](/cfr/42/part410.md) of this chapter; or
    - (ii) Services excluded from coverage as custodial care or services not reasonable and necessary, but reimbursable in accordance with [§§ 405.332 through 405.334](/cfr/42/405.332..405.334.md) of this chapter, pertaining to limitation of liability.
  - (2) **Sources of services.** The services must have been furnished by a provider, nonparticipating hospital, or supplier that was, at the time it furnished the services, qualified to have payment made for them.
  - (3) **Beneficiary of services.** Except as provided in [§ 409.68](/cfr/42/409.68.md) of this chapter, the services must have been furnished while the individual was eligible to have payment made for them. ([Section 409.68](/cfr/42/409.68.md) provides for payment of inpatient hospital services furnished before the hospital is notified that the beneficiary has exhausted the Medicare benefits available for the current benefit period.)
  - (4) **Certification of need for services.** When required, the provider must obtain certification and recertification of the need for the services in accordance with subpart B of this part.
  - (5) **Claim for payment.** The provider, supplier, or beneficiary, as appropriate, must file a claim that includes or makes reference to a request for payment, in accordance with subpart C of this part.
  - (6) **Sufficient information.** The provider, supplier, or beneficiary, as appropriate, must furnish to the intermediary or carrier sufficient information to determine whether payment is due and the amount of payment.
- (b) Additional conditions applicable in certain circumstances or to certain services are set forth in other sections of this part.

## Notes

### Amendments

[53 FR 6635, Mar. 2, 1988; 53 FR 12945, Apr. 20, 1988; 60 FR 38271, July 26, 1995]

### Authority

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

### Source

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

### Amendments

[53 FR 6635, Mar. 2, 1988; 53 FR 12945, Apr. 20, 1988; 60 FR 38271, July 26, 1995]