Title 42, Part 419 — Prospective Payment Systems for Hospital Outpatient Department Services

Basis and scope.

Basis of payment.

Hospitals subject to the hospital outpatient prospective payment system.

Hospital services subject to the outpatient prospective payment system.

Hospital services excluded from payment under the hospital outpatient prospective payment system.

Base expenditure target for calendar year 1999.

Ambulatory payment classification (APC) system and payment weights.

Calculation of prospective payment rates for hospital outpatient services.

Payment concepts.

Calculation of national beneficiary copayment amounts and national Medicare program payment amounts.

Hospital election to reduce coinsurance.

Adjustments to national program payment and beneficiary copayment amounts.

Payment reductions for procedures.

Payment and copayment reduction for devices replaced without cost or when full or partial credit is received.

Requirements under the Hospital Outpatient Quality Reporting (OQR) Program.

Coding and payment for Category B Investigational Device Exemption (IDE) studies.

Definition of excepted items and services.

Additional payment for technetium-99m (Tc-99m) derived from domestically produced molybdenum-99 (Mo-99).

Annual review.

Limitations on administrative and judicial review.

Transitional pass-through payments: General rules.

Transitional pass-through payments: Drugs and biologicals.

Transitional pass-through payments: Medical devices.

Transitional adjustments to limit decline in payments.

Payment reduction for certain X-ray imaging services.

Basis and scope of this subpart.

Definitions.

Prior authorization for certain covered hospital outpatient department services.

List of hospital outpatient department services requiring prior authorization.

§§ 419.84-419.89 [Reserved]

Basis and scope of subpart.

Definitions.

Payment to rural emergency hospitals.

Payment for an off-campus provider-based department of a rural emergency hospital.

Preclusion of administrative and judicial review.

Requirements under the Rural Emergency Hospital Quality Reporting (REHQR) Program.