Code of Federal Regulations (alpha)

CFR /  Title 42  /  Part 414: Payment For Part B Medical And Other Health Services

Section No. Description
Section 414.1 Definitions
Section 414.2 Fee schedule areas
Section 414.4 Hospital services paid under Medicare Part B when a Part A hospital inpatient claim is denied because the inpatient admission
Section 414.5 Formula for computing fee schedule amounts
Section 414.20 Medicare payment basis
Section 414.21 Relative value units (RVUs)
Section 414.22 Publication of RVUs and direct PE inputs
Section 414.24 Determining the GAF
Section 414.26 Conversion factors
Section 414.28 Conversion factor update
Section 414.30 Determining payments for certain physicians' services furnished in facility settings
Section 414.32 Payment for services and supplies incident to a physician's service
Section 414.34 Payment for drugs incident to a physician's service
Section 414.36 Special rules for payment of care plan oversight
Section 414.39 Coding and ancillary policies
Section 414.40 Adjustment for first 4 years of practice
Section 414.42 Transition rules
Section 414.44 Additional rules for payment of anesthesia services
Section 414.46 Limits on actual charges of nonparticipating suppliers
Section 414.48 Physician or other supplier billing for diagnostic tests performed or interpreted by a physician who does not share a practice
Section 414.50 Payment for physician assistants' services
Section 414.52 Payment for certified nurse-midwives' services
Section 414.54 Payment for nurse practitioners' and clinical nurse specialists' services
Section 414.56 Payment of charges for physician services to patients in providers
Section 414.58 Payment for the services of CRNAs
Section 414.60 Payment for anesthesia services furnished by a teaching CRNA
Section 414.61 Fee schedule for clinical psychologist services
Section 414.62 Payment for outpatient diabetes self-management training
Section 414.63 Payment for medical nutrition therapy
Section 414.64 Payment for telehealth services
Section 414.65 Incentive payments for physician scarcity areas
Section 414.66 Incentive payments for services furnished in Health Professional Shortage Areas
Section 414.67 Imaging accreditation
Section 414.68 Incentive payment for primary care services
Section 414.80 Physician Quality Reporting System (PQRS)
Section 414.90 Electronic Prescribing Incentive Program
Section 414.92 Purpose
Section 414.100 General payment rules
Section 414.102 PEN Items and Services
Section 414.104 Application of competitive bidding information
Section 414.105 Splints and casts
Section 414.106 IOLs inserted in a physician's office
Section 414.108 Purpose
Section 414.200 Definitions
Section 414.202 General payment rules
Section 414.210 Inexpensive or routinely purchased items
Section 414.220 Items requiring frequent and substantial servicing
Section 414.222 Customized items
Section 414.224 Oxygen and oxygen equipment
Section 414.226 Prosthetic and orthotic devices
Section 414.228 Other durable medical equipment--capped rental items
Section 414.229 Determining a period of continuous use
Section 414.230 Special payment rules for transcutaneous electrical nerve stimulators (TENS)
Section 414.232 Scope of subpart
Section 414.300 Determination of reasonable charges for physician services furnished to renal dialysis patients
Section 414.310 Initial method of payment
Section 414.313 Monthly capitation payment method
Section 414.314 Payment for physician services to patients in training for self-dialysis and home dialysis
Section 414.316 Determination of reasonable charges for physician renal transplantation services
Section 414.320 Payment for home dialysis equipment, supplies, and support services
Section 414.330 Payment for EPO furnished to a home dialysis patient for use in the home
Section 414.335 Purpose and basis
Section 414.400 Definitions
Section 414.402 Scope and applicability
Section 414.404 Implementation of programs
Section 414.406 Payment rules
Section 414.408 Special payment rules
Section 414.409 Phased-in implementation of competitive bidding programs
Section 414.410 Special rule in case of competitions for diabetic testing strips conducted on or after January 1, 2011
Section 414.411 Submission of bids under a competitive bidding program
Section 414.412 Conditions for awarding contracts
Section 414.414 Determination of competitive bidding payment amounts
Section 414.416 Opportunity for networks
Section 414.418 Physician or treating practitioner authorization and consideration of clinical efficiency and value of items
Section 414.420 Terms of contracts
Section 414.422 Appeals Process for Termination of Competitive Bidding Contract
Section 414.423 Administrative or judicial review
Section 414.424 Claims for damages
Section 414.425 Adjustments to competitively bid payment amounts to reflect changes in the HCPCS
Section 414.426 Basis and scope
Section 414.500 Definitions
Section 414.502 Procedures for public consultation for payment for a new clinical diagnostic laboratory test
Section 414.506 Payment for a new clinical diagnostic laboratory test
Section 414.508 Reconsideration of basis for and amount of payment for a new clinical diagnostic laboratory test
Section 414.509 Laboratory date of service for clinical laboratory and pathology specimens
Section 414.510 Purpose
Section 414.601 Definitions
Section 414.605 Basis of payment
Section 414.610 Transition to the ambulance fee schedule
Section 414.615 Transition from regional to national ambulance fee schedule
Section 414.617 Publication of the ambulance fee schedule
Section 414.620 Limitation on review
Section 414.625 Purpose
Section 414.701 Definitions
Section 414.704 Basis of payment
Section 414.707 Purpose
Section 414.800 Definitions
Section 414.802 Basis of payment
Section 414.804 Penalties associated with the failure to submit timely and accurate ASP data
Section 414.806 Basis and scope
Section 414.900 Definitions
Section 414.902 Average sales price as the basis for payment
Section 414.904 Competitive acquisition program as the basis for payment
Section 414.906 Competitive acquisition program
Section 414.908 Bidding process
Section 414.910 Conflicts of interest
Section 414.912 Terms of contract
Section 414.914 Dispute resolution for vendors and beneficiaries
Section 414.916 Dispute resolution and process for suspension or termination of approved CAP contract and termination of physician
Section 414.917 Assignment
Section 414.918 Judicial review
Section 414.920 Compendia for determination of medically-accepted indications for off-label uses of drugs and biologicals in an anti-cancer
Section 414.930 Purpose
Section 414.1000 Basis of payment
Section 414.1001 Basis and scope
Section 414.1100 Payment for Comprehensive Outpatient Rehabilitation Facility (CORF) services
Section 414.1105 Basis and scope
Section 414.1200 Definitions
Section 414.1205 Application of the value-based payment modifier
Section 414.1210 Performance and payment adjustment periods for the value-based payment modifier
Section 414.1215 Reporting mechanisms for the value-based payment modifier
Section 414.1220 Alignment of Physician Quality Reporting System quality measures and quality measures for the value-based payment
Section 414.1225 Additional measures for groups and solo practitioners
Section 414.1230 Cost measures
Section 414.1235 Attribution for quality of care and cost measures
Section 414.1240 Scoring methods for the value-based payment modifier using the quality-tiering approach
Section 414.1245 Benchmarks for quality of care measures
Section 414.1250 Benchmarks for cost measures
Section 414.1255 Composite scores
Section 414.1260 Reliability of measures
Section 414.1265 Determination and calculation of Value-Based Payment Modifier adjustments
Section 414.1270 Value-based payment modifier quality-tiering scoring methodology
Section 414.1275 Limitation on review
Section 414.1280 Informal inquiry process
Section 414.1285 Basis and scope