42 CFR 411.15 - Particular services excluded from coverage
| Cite as | 42 CFR 411.15 |
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92 practice notes
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Maximum Comfort, Inc. v. Thompson, No. CIV. S-03-1584 LKK/PA.
...services and equipment, 42 U.S.C. §§ 1395k, 1395l, 1395x(s), and provide for exclusions from coverage. 42 U.S.C. § 1395y(a)(2)-(16); 42 C.F.R. § 411.15(a)-(j). In all cases, Medicare coverage is limited to services that are medically "reasonable and necessary" for the diagnosis or treatment......
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U.S. ex rel. Smith v. Yale University, No. 3:00CV1359 (PCD).
...and necessary for the diagnosis or treatment of illness or injury or to improve the functioning of a malformed body member"); 42 C.F.R. § 411.15(k); see also Mikes, 274 F.3d at 702 (holding that "in submitting a Medicare reimbursement form, a defendant implicitly certifies compliance with §......
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Yale-New Haven Hosp., Inc. v. Thompson, No. 3:99CV2546 (GLG).
...... are not reasonable and necessary for the diagnosis and treatment of illness or injury.... 42 U.S.C. § 1395y(a)(1)(A); see also 42 C.F.R. § 411.15(k)(1); Goodman v. Sullivan, 891 F.2d 449, 450 (2d Cir.1989). The Act, however, does not define the term "reasonable and necessary" but instea......
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United States ex rel. Colquitt v. Abbott Labs., No. 3:06–cv–1769–M.
...exceptions not relevant to this case, federal regulations prohibit Medicare coverage for experimental or investigational devices. 42 C.F.R. § 411.15( o). A device is investigational if it has not been approved by the FDA through the premarket approval process or the 510(k) clearance process......
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63 cases
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Maximum Comfort, Inc. v. Thompson, No. CIV. S-03-1584 LKK/PA.
...services and equipment, 42 U.S.C. §§ 1395k, 1395l, 1395x(s), and provide for exclusions from coverage. 42 U.S.C. § 1395y(a)(2)-(16); 42 C.F.R. § 411.15(a)-(j). In all cases, Medicare coverage is limited to services that are medically "reasonable and necessary" for the diagnosis or treatment......
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U.S. ex rel. Smith v. Yale University, No. 3:00CV1359 (PCD).
...and necessary for the diagnosis or treatment of illness or injury or to improve the functioning of a malformed body member"); 42 C.F.R. § 411.15(k); see also Mikes, 274 F.3d at 702 (holding that "in submitting a Medicare reimbursement form, a defendant implicitly certifies compliance with §......
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Yale-New Haven Hosp., Inc. v. Thompson, No. 3:99CV2546 (GLG).
...... are not reasonable and necessary for the diagnosis and treatment of illness or injury.... 42 U.S.C. § 1395y(a)(1)(A); see also 42 C.F.R. § 411.15(k)(1); Goodman v. Sullivan, 891 F.2d 449, 450 (2d Cir.1989). The Act, however, does not define the term "reasonable and necessary" but instea......
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United States ex rel. Colquitt v. Abbott Labs., No. 3:06–cv–1769–M.
...exceptions not relevant to this case, federal regulations prohibit Medicare coverage for experimental or investigational devices. 42 C.F.R. § 411.15( o). A device is investigational if it has not been approved by the FDA through the premarket approval process or the 510(k) clearance process......
Request a trial to view additional results
3 firm's commentaries
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CMS Issues Guidance for COVID-19 Treatments & Vaccines
...the vaccine and its administration as a result of amendments made to the Social Security Act § 1861(s)(10) and 42 C.F.R. §§ 410.57, 410.152, 411.15, 414.701, 414.707, 414.900, and These statutory and regulatory amendments together incorporate COVID-19 vaccines as preventative immunizations ......
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6 Takeaways From LabSolutions 'Unnecessary Testing' Verdict
...and necessary for the diagnosis or treatment of illness or injury or to improve the functioning of a malformed body member," and 42 C.F.R. § 411.15(a)(1), which provides that Medicare does not cover "examinations performed for a purpose other than treatment or diagnosis of a specific illnes......
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Decoding DOJ’s Crackdown on Genetic Testing: High-Profile Indictments and Practical Takeaways for the Cancer and Pharma Genomics Industries
...and necessary for the diagnosis or treatment of illness or injury or to improve the functioning of a malformed body member,” and 42 C.F.R. § 411.15(a)(1), which provides that, unless an exception applies, there is no coverage for “[e]xaminations performed for a purpose other than treatment ......