---
kind: "section"
citation: "42 C.F.R. § 440.90"
title: "42"
number: "440.90"
heading: "Clinic services."
url: "https://uscodex.org/cfr/42/440.90"
---

# §440.90. Clinic services.


Clinic services means preventive, diagnostic, therapeutic, rehabilitative, or palliative services that are furnished by a facility that is not part of a hospital but is organized and operated to provide medical care to outpatients. The term includes the following services furnished to outpatients (services in [paragraphs (a) through (c)](#a..c) of this section are a mandatory part of clinic services, while services in paragraphs [(d)](#d) and [(e)](#e) of this section are optional):

- (a) **Services furnished at the clinic by or under the direction of a physician or dentist.**
- (b) Services furnished outside the clinic, by clinic personnel under the direction of a physician, to an individual who does not reside in a permanent dwelling or does not have a fixed home or mailing address.
- (c) Services furnished outside a clinic that is a facility of the Indian Health Service, whether operated by the Indian Health Service or by a Tribe or Tribal organization (as authorized by the Indian Self-Determination and Education Assistance Act (ISDEAA), Pub. L. 93-638), by clinic personnel under the direction of a physician.
- (d) Services furnished outside of a clinic that is primarily organized for the care and treatment of outpatients with behavioral health disorders, including mental health and substance use disorders, by clinic personnel under the direction of a physician.
- (e) Services furnished outside of a clinic that is located in a rural area and is not a rural health clinic (as referenced in section 1905(a)(2)(B) of the Social Security Act and [§ 440.20(b)](/cfr/42/440.20.md?p=b)) by clinic personnel under the direction of a physician. States must include a definition of rural area in their State plans. This definition must be either a definition adopted and used by a Federal governmental agency for programmatic purposes, or a definition adopted by a State governmental agency with a role in setting State rural health policy.

## Notes

### Amendments

[56 FR 8851, Mar. 1, 1991, as amended at 60 FR 61486, Nov. 30, 1995; 89 FR 94591, Nov. 27, 2024]

### Authority

Authority: 42 U.S.C. 1302.

### Source

Source: 43 FR 45224, Sept. 29, 1978, unless otherwise noted.

### Amendments

[56 FR 8851, Mar. 1, 1991, as amended at 60 FR 61486, Nov. 30, 1995; 89 FR 94591, Nov. 27, 2024]