---
kind: "section"
citation: "42 C.F.R. § 512.265"
title: "42"
number: "512.265"
heading: "Payment."
url: "https://uscodex.org/cfr/42/512.265"
---

# §512.265. Payment.

- (a) **Payment for episodes.** CMS pays an RO participant for all included RT services furnished to an RO beneficiary during a completed RO episode as follows:
  - (1) CMS pays a Professional participant a participant-specific professional episode payment for the professional component furnished to an RO beneficiary during an RO episode.
  - (2) CMS pays a Technical participant a participant-specific technical episode payment for the technical component furnished to an RO beneficiary during an RO episode.
  - (3) CMS pays a Dual participant a participant-specific professional episode payment and a participant-specific technical episode payment for the professional component and technical component furnished to an RO beneficiary during an RO episode.
- (b) **Payment installments.** CMS makes each of the payments described in [paragraph (a)](#a) of this section in two equal installments, as follows:
  - (1) CMS pays one-half of a participant-specific professional episode payment to a Professional participant or Dual participant or one-half of the participant-specific technical episode payment to a Technical participant or Dual participant after the RO participant bills an RO Model-specific HCPCS code with a SOE modifier.
  - (2) CMS pays the remaining half of a participant-specific professional episode payment to a Professional participant or Dual participant or one-half of the participant-specific technical episode payment to a Technical participant or Dual participant after the RO participant bills an RO Model-specific HCPCS code with an EOE modifier.
- (c) **Duplicate RT services.** Duplicate RT services are reimbursed at the FFS amount, whether or not the RT provider or RT supplier that furnished such services is an RO participant.

## Notes

### Authority

Authority: 42 U.S.C. 1302, 1315a, and 1395hh.

### Source

Source: 85 FR 61362, Sept. 29, 2020, unless otherwise noted.