42 CFR § 512.265 - Payment.
---
identifier: "/us/cfr/t42/s512.265"
source: "ecfr"
legal_status: "authoritative_unofficial"
title: "42 CFR § 512.265 - Payment."
title_number: 42
title_name: "Public Health"
section_number: "512.265"
section_name: "Payment."
chapter_name: "CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES"
subchapter_number: "H"
subchapter_name: "HEALTH CARE INFRASTRUCTURE AND MODEL PROGRAMS"
part_number: "512"
part_name: "STANDARD PROVISIONS FOR MANDATORY INNOVATION CENTER MODELS AND SPECIFIC PROVISIONS FOR CERTAIN MODELS"
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, 1315a, and 1395hh."
regulatory_source: "85 FR 61362, Sept. 29, 2020, unless otherwise noted."
cfr_part: "512"
---
# 512.265 Payment.
(a) *Payment for episodes.* CMS pays an RO participant for all included RT services furnished to an RO beneficiary during a completed RO episode as follows:
(1) CMS pays a Professional participant a participant-specific professional episode payment for the professional component furnished to an RO beneficiary during an RO episode.
(2) CMS pays a Technical participant a participant-specific technical episode payment for the technical component furnished to an RO beneficiary during an RO episode.
(3) CMS pays a Dual participant a participant-specific professional episode payment and a participant-specific technical episode payment for the professional component and technical component furnished to an RO beneficiary during an RO episode.
(b) *Payment installments.* CMS makes each of the payments described in paragraph (a) of this section in two equal installments, as follows:
(1) CMS pays one-half of a participant-specific professional episode payment to a Professional participant or Dual participant or one-half of the participant-specific technical episode payment to a Technical participant or Dual participant after the RO participant bills an RO Model-specific HCPCS code with a SOE modifier.
(2) CMS pays the remaining half of a participant-specific professional episode payment to a Professional participant or Dual participant or one-half of the participant-specific technical episode payment to a Technical participant or Dual participant after the RO participant bills an RO Model-specific HCPCS code with an EOE modifier.
(c) *Duplicate RT services.* Duplicate RT services are reimbursed at the FFS amount, whether or not the RT provider or RT supplier that furnished such services is an RO participant.