42 CFR § 411.53 - Basis for conditional Medicare payment in no-fault cases.

---
identifier: "/us/cfr/t42/s411.53"
source: "ecfr"
legal_status: "authoritative_unofficial"
title: "42 CFR § 411.53 - Basis for conditional Medicare payment in no-fault cases."
title_number: 42
title_name: "Public Health"
section_number: "411.53"
section_name: "Basis for conditional Medicare payment in no-fault cases."
chapter_name: "CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES"
subchapter_number: "B"
subchapter_name: "MEDICARE PROGRAM"
part_number: "411"
part_name: "EXCLUSIONS FROM MEDICARE AND LIMITATIONS ON MEDICARE PAYMENT"
positive_law: false
currency: "2026-04-05"
last_updated: "2026-04-05"
format_version: "1.1.0"
generator: "[email protected]"
authority: "42 U.S.C. 1302, 1395w-101 through 1395w-152, 1395hh, and 1395nn."
regulatory_source: "54 FR 41734, Oct. 11, 1989, unless otherwise noted."
cfr_part: "411"
---


# 411.53 Basis for conditional Medicare payment in no-fault cases.

(a) A conditional Medicare payment may be made in no-fault cases under either of the following circumstances:

(1) The beneficiary has filed a proper claim for no-fault insurance benefits but the intermediary or carrier determines that the no-fault insurer will not pay promptly for any reason other than the circumstances described in § 411.32(a)(1). This includes cases in which the no-fault insurance carrier has denied the claim.

(2) The beneficiary, because of physical or mental incapacity, failed to meet a claim-filing requirement stipulated in the policy.

(b) Any conditional payment that CMS makes is conditioned on reimbursement to CMS in accordance with subpart B of this part.

[71 FR 9470, Feb. 24, 2006]