Hospital services subject to the outpatient prospective payment system.

42 CFR § 419.21

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42 CFR § 419.21

Hospital services subject to the outpatient prospective payment system. Except for services described in § 419.22, 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 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 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.

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