42 CFR 414.210 - General payment rules

Cite as42 CFR 414.210
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23 practice notes
4 cases
  • Almy v. Sebelius, Civil Action No. RDB–08–1245.
    • United States
    • United States District Courts. 1st Circuit. United States District Courts. 1st Circuit. District of Massachusetts
    • September 3, 2010
    ...amount that is equal to “80 percent of the lesser of ... the actual charge for the item; [or] the fee schedule amount for the item.” 42 C.F.R. § 414.210(a). If a DME item is denied coverage under Medicare and “neither the beneficiary nor the supplier knew, or reasonably could have been expe......
  • Almy v. Sebelius, No. 10–2241.
    • United States
    • United States Courts of Appeals. United States Court of Appeals (4th Circuit)
    • April 26, 2012
    ...80 percent of the lesser of either the actual charge for the item or the fee schedule amount for the item. 42 U.S.C. § 1395m(a)(1); 42 C.F.R. § 414.210(a). The ALJ and MAC made findings that a fee schedule was properly implemented by a local contractor pursuant to guidance from the Secretar......
  • United States v. Iwuala, No. 13–2497.
    • United States
    • U.S. Court of Appeals — First Circuit
    • June 10, 2015
    ...a fee schedule predicated in part on a percentage of the amount claimed and, therefore, always pays less than the amount billed. See 42 C.F.R. § 414.210 (explaining that Medicare generally pays for DME “on the basis of 80 percent of the lesser of ... [t]he actual charge for the item [or] [t......
  • Nichole Med. Equip. & Supply, Inc. v. United States, No. 12-364C
    • United States
    • Court of Federal Claims
    • February 25, 2013
    ...to one or more beneficiaries. See generally 42 U.S.C. § 1395m(a) (2006) (providing for payment on durable medical equipment); 42 C.F.R. § 414.210 (2012) (stating payment rules). In order to be reimbursed, the supplier sends a certificate of medical necessity to a Medicare contractor. See Un......
11 firm's commentaries
  • Dickinson Wright COVID-19 Resource Guide
    • United States
    • JD Supra United States
    • September 15, 2020
    ...requirements of the IPPS. Payments for durable medical equipment (“DME”) are transitioning based on a list of factors enumerated in 42 C.F.R. 414.210. Medicare had originally established a transition period that went through December 31, 2020. However, Congress has extended these transition......
  • CMS Interim Rule Makes Sweeping Changes in Response to COVID-19 Public Health Emergency
    • United States
    • LexBlog United States
    • May 8, 2020
    ...to maintain that status. Section I. Durable Medical Equipment (DME) Interim Pricing in the CARES Act CMS is revising regulations at 42 CFR § 414.210(g)(9) to implement the CARES Act directive to increase fee schedule amounts for certain DME items and services. CMS is increasing the fee sche......
  • CMS Interim Rule Makes Sweeping Changes in Response to COVID-19 Public Health Emergency
    • United States
    • JD Supra United States
    • May 11, 2020
    ...to maintain that status. Section I. Durable Medical Equipment (DME) Interim Pricing in the CARES Act CMS is revising regulations at 42 CFR § 414.210(g)(9) to implement the CARES Act directive to increase fee schedule amounts for certain DME items and services. CMS is increasing the fee sche......
  • Title III of the CARES Act: Supporting America’s Health Care System in the Fight Against the Coronavirus
    • United States
    • JD Supra United States
    • April 2, 2020
    ...period items and services furnished in rural and noncontiguous areas will be reimbursed pursuant to the transition rule, described in 42 C.F.R. §414.210(g)(9)(iii). For areas other than rural and noncontiguous areas, items and services shall be reimbursed pursuant the transition rule descri......
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