42 C.F.R. § 405.207 Services related to a noncovered device.
Title 42 - Public Health
(a) When payment is not made. Medicare payment is not made for medical and hospital services that are related to the use of a device that is not covered because CMS determines the device is not “reasonable” and “necessary” under section 1862(a)(1)(A) of the Act or because it is excluded from coverage for other reasons. These services include all services furnished in preparation for the use of a noncovered device, services furnished contemporaneously with and necessary to the use of a noncovered device, and services furnished as necessary after-care that are incident to recovery from the use of the device or from receiving related noncovered services. (b) When payment is made. Medicare payment may be made for— (1) Covered services to treat a condition or complication that arises due to the use of a noncovered device or a noncovered device-related service; or (2) Routine care services related to experimental/investigational (Category A) devices as defined in §405.201(b); and furnished in conjunction with an FDA-approved clinical trial. The trial must meet criteria established through the national coverage determination process; and if the trial is initiated before January 1, 2010, the device must be determined as intended for use in the diagnosis, monitoring or treatment of an immediately life-threatening disease or condition. (3) Routine care services related to a non-experimental/investigational (Category B) device defined in §405.201(b) that is furnished in conjunction with an FDA-approved clinical trial. [60 FR 48423, Sept. 19, 1995, as amended at 69 FR 66420, Nov. 15, 2004]
Title 42: Public Health
PART 405—FEDERAL HEALTH INSURANCE FOR THE AGED AND DISABLED
Subpart B—Medical Services Coverage Decisions That Relate to Health Care Technology
§ 405.207 Services related to a noncovered device.
