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e-CFR data is current as of July 13, 2020

Title 42Chapter IVSubchapter BPart 419


TITLE 42—Public Health

CHAPTER IV—CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED)

SUBCHAPTER B—MEDICARE PROGRAM (CONTINUED)

PART 419—PROSPECTIVE PAYMENT SYSTEM FOR HOSPITAL OUTPATIENT DEPARTMENT SERVICES

rule

Subpart A—GENERAL PROVISIONS

§419.1
Basis and scope.
§419.2
Basis of payment.
rule

Subpart B—CATEGORIES OF HOSPITALS AND SERVICES SUBJECT TO AND EXCLUDED FROM THE HOSPITAL OUTPATIENT PROSPECTIVE PAYMENT SYSTEM

§419.20
Hospitals subject to the hospital outpatient prospective payment system.
§419.21
Hospital services subject to the outpatient prospective payment system.
§419.22
Hospital services excluded from payment under the hospital outpatient prospective payment system.
rule

Subpart C—BASIC METHODOLOGY FOR DETERMINING PROSPECTIVE PAYMENT RATES FOR HOSPITAL OUTPATIENT SERVICES

§419.30
Base expenditure target for calendar year 1999.
§419.31
Ambulatory payment classification (APC) system and payment weights.
§419.32
Calculation of prospective payment rates for hospital outpatient services.
rule

Subpart D—PAYMENTS TO HOSPITALS

§419.40
Payment concepts.
§419.41
Calculation of national beneficiary copayment amounts and national Medicare program payment amounts.
§419.42
Hospital election to reduce coinsurance.
§419.43
Adjustments to national program payment and beneficiary copayment amounts.
§419.44
Payment reductions for procedures.
§419.45
Payment and copayment reduction for devices replaced without cost or when full or partial credit is received.
§419.46
Participation, data submission, and validation requirements under the Hospital Outpatient Quality Reporting (OQR) Program.
§419.48
Definition of excepted items and services.
rule

Subpart E—UPDATES

§419.50
Annual review.
rule

Subpart F—LIMITATIONS ON REVIEW

§419.60
Limitations on administrative and judicial review.
rule

Subpart G—TRANSITIONAL PASS-THROUGH PAYMENTS

§419.62
Transitional pass-through payments: General rules.
§419.64
Transitional pass-through payments: Drugs and biologicals.
§419.66
Transitional pass-through payments: Medical devices.
rule

Subpart H—TRANSITIONAL CORRIDORS

§419.70
Transitional adjustments to limit decline in payments.
§419.71
Payment reduction for certain X-ray imaging services.
rule

Subpart I—PRIOR AUTHORIZATION FOR OUTPATIENT DEPARTMENT SERVICES

§419.80
Basis and scope of this subpart.
§419.81
Definitions.
§419.82
Prior authorization for certain covered hospital outpatient department services.
§419.83
List of hospital outpatient department services requiring prior authorization.
§§419.84-419.89
[Reserved]

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