CFR /  Title 42  /  Part 411: Exclusions From Medicare And Limitations On Medicare Payment

Section No.	Description
Section 411.1	Conclusive effect of QIO determinations on payment of claims
Section 411.2	Services for which neither the beneficiary nor any other person is legally obligated to pay
Section 411.4	Services furnished by a Federal provider of services or other Federal agency
Section 411.6	Services that must be furnished at public expense under a Federal law or Federal Government contract
Section 411.7	Services paid for by a Government entity
Section 411.8	Services furnished outside the United States
Section 411.9	Services required as a result of war
Section 411.10	Charges imposed by an immediate relative or member of the beneficiary's household
Section 411.12	Particular services excluded from coverage
Section 411.15	Basis and scope
Section 411.20	Definitions
Section 411.21	Reimbursement obligations of primary payers and entities that received payment from primary payers
Section 411.22	Beneficiary's cooperation
Section 411.23	Recovery of conditional payments
Section 411.24	Primary payer's notice of primary payment responsibility
Section 411.25	Subrogation and right to intervene
Section 411.26	Waiver of recovery and compromise of claims
Section 411.28	Effect of primary payment on benefit utilization and deductibles
Section 411.30	Authority to bill primary payers for full charges
Section 411.31	Basis for Medicare secondary payments
Section 411.32	Amount of Medicare secondary payment
Section 411.33	Limitations on charges to a beneficiary or other party when a workers' compensation plan, a no-fault insurer, or an
Section 411.35	Amount of Medicare recovery when a primary payment is made as a result of a judgment or settlement
Section 411.37	Automobile and liability insurance (including self- insurance), no-fault insurance, and workers' compensation: Final
Section 411.39	General provisions
Section 411.40	Beneficiary's responsibility with respect to workers' compensation
Section 411.43	Basis for conditional Medicare payment in workers' compensation cases
Section 411.45	Lump-sum payments
Section 411.46	Apportionment of a lump-sum compromise settlement of a workers' compensation claim
Section 411.47	General provisions
Section 411.50	Beneficiary's responsibility with respect to no-fault insurance
Section 411.51	Basis for conditional Medicare payment in liability cases
Section 411.52	Basis for conditional Medicare payment in no-fault cases
Section 411.53	Limitation on charges when a beneficiary has received a liability insurance payment or has a claim pending against a
Section 411.54	Basis and scope
Section 411.100	Definitions
Section 411.101	Basic prohibitions and requirements
Section 411.102	Prohibition against financial and other incentives
Section 411.103	Current employment status
Section 411.104	Aggregation rules
Section 411.106	Taking into account entitlement to Medicare
Section 411.108	Basis for determination of nonconformance
Section 411.110	Documentation of conformance
Section 411.112	Determination of nonconformance
Section 411.114	Notice of determination of nonconformance
Section 411.115	Appeals
Section 411.120	Hearing procedures
Section 411.121	Hearing officer's decision
Section 411.122	Administrator's review of hearing decision
Section 411.124	Reopening of determinations and decisions
Section 411.126	Referral to Internal Revenue Service (IRS)
Section 411.130	Scope
Section 411.160	Prohibition against taking into account Medicare eligibility or entitlement or differentiating benefits
Section 411.161	Medicare benefits secondary to group health plan benefits
Section 411.162	Coordination of benefits: Dual entitlement situations
Section 411.163	Basis for conditional Medicare payments
Section 411.165	General provisions
Section 411.170	Medicare benefits secondary to group health plan benefits
Section 411.172	Basis for Medicare primary payments
Section 411.175	Basis
Section 411.200	Definitions
Section 411.201	Medicare benefits secondary to LGHP benefits
Section 411.204	Basis for Medicare primary payments and limits on secondary payments
Section 411.206	Scope of subpart
Section 411.350	Definitions
Section 411.351	Group practice
Section 411.352	Prohibition on certain referrals by physicians and limitations on billing
Section 411.353	Financial relationship, compensation, and ownership or investment interest
Section 411.354	General exceptions to the referral prohibition related to both ownership/investment and compensation
Section 411.355	Exceptions to the referral prohibition related to
Section 411.356	Exceptions to the referral prohibition related to compensation arrangements
Section 411.357	Reporting requirements
Section 411.361	Additional requirements concerning physician ownership and investment in hospitals
Section 411.362	Advisory opinions relating to physician referrals
Section 411.370	Procedure for submitting a request
Section 411.372	Certification
Section 411.373	Fees for the cost of advisory opinions
Section 411.375	Expert opinions from outside sources
Section 411.377	Withdrawing a request
Section 411.378	When CMS accepts a request
Section 411.379	When CMS issues a formal advisory opinion
Section 411.380	CMS's right to rescind advisory opinions
Section 411.382	Disclosing advisory opinions and supporting information
Section 411.384	CMS's advisory opinions as exclusive
Section 411.386	Parties affected by advisory opinions
Section 411.387	When advisory opinions are not admissible evidence
Section 411.388	Range of the advisory opinion
Section 411.389	Payment for custodial care and services not reasonable and necessary
Section 411.400	Indemnification of beneficiary
Section 411.402	Criteria for determining that a beneficiary knew that services were excluded from coverage as custodial care or as not
Section 411.404	Criteria for determining that a provider, practitioner, or supplier knew that services were excluded from coverage as
Section 411.406	Refunds of amounts collected for physician services not reasonable and necessary, payment not accepted on an
Section 411.408	Scope of part