42 C.F.R. Subpart A—General Provisions
Title 42 - Public Health
Link to an amendment published at 71 FR 48409, Aug. 18, 2006. This part implements the following provisions of the Act:
1802—Rules for private contracts by Medicare beneficiaries. 1833—Rules for payment for most Part B services. 1834(a) and (h)—Amounts and frequency of payments for durable medical equipment and for prosthetic devices and orthotics and prosthetics. 1834(l)—Establishment of a fee schedule for ambulance services. 1834(m)—Rules for Medicare reimbursement for telehealth services. 1842(o)—Rules for payment of certain drugs and biologicals. 1848—Fee schedule for physician services. 1881(b)—Rules for payment for services to ESRD beneficiaries. 1887—Payment of charges for physician services to patients in providers. [67 FR 9132, Feb. 27, 2002, as amended at 69 FR 1116, Jan. 7, 2004] As used in this part, unless the context indicates otherwise— AA stands for anesthesiologist assistant. AHPB stands for adjusted historical payment basis. CF stands for conversion factor. CRNA stands for certified registered nurse anesthetist. CY stands for calendar year. FY stands for fiscal year. GAF stands for geographic adjustment factor. GPCI stands for geographic practice cost index. HCPCS stands for CMS Common Procedure Coding System. Physician services means the following services to the extent that they are covered by Medicare: (1) Professional services of doctors of medicine and osteopathy (including osteopathic practitioners), doctors of optometry, doctors of podiatry, doctors of dental surgery and dental medicine, and chiropractors. (2) Supplies and services covered “incident to” physician services (excluding drugs as specified in §414.36). (3) Outpatient physical and occupational therapy services if furnished by a person or an entity that is not a Medicare provider of services as defined in §400.202 of this chapter. (4) Diagnostic x-ray tests and other diagnostic tests (excluding diagnostic laboratory tests paid under the fee schedule established under section 1833(h) of the Act). (5) X-ray, radium, and radioactive isotope therapy, including materials and services of technicians. (6) Antigens, as described in section 1861(s)(2)(G) of the Act. (7) Bone mass measurement. RVU stands for relative value unit. (8) Screening mammography services. [56 FR 59624, Nov. 25, 1991, as amended at 57 FR 42492, Sept. 15, 1992; 58 FR 63686, Dec. 2, 1993; 59 FR 63463, Dec. 8, 1994; 60 FR 63177, Dec. 8, 1995; 63 FR 34328, June 24, 1998; 66 FR 55322, Nov. 1, 2001] (a) General. CMS establishes physician fee schedule areas that generally conform to the geographic localities in existence before January 1, 1992. (b) Changes. CMS announces proposed changes to fee schedule areas in the [59 FR 63463, Dec. 8, 1994]
Title 42: Public Health
PART 414—PAYMENT FOR PART B MEDICAL AND OTHER HEALTH SERVICES
Subpart A—General Provisions
§ 414.1 Basis and scope.
§ 414.2 Definitions.
§ 414.4 Fee schedule areas.
