C.F.R. » Title 42 » CHAPTER IV—CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES › SUBCHAPTER B—MEDICARE PROGRAM › PART 409—HOSPITAL INSURANCE BENEFITS › Subpart B—Inpatient Hospital Services and Inpatient Critical Access Hospital Services

42 C.F.R. § 409.10

Included services

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(a) Subject to the conditions, limitations, and exceptions set forth in this subpart, the term “inpatient hospital or inpatient CAH services” means the following services furnished to an inpatient of a participating hospital or of a participating CAH or, in the case of emergency services or services in foreign hospitals, to an inpatient of a qualified hospital:

(1) Bed and board.

(2) Nursing services and other related services.

(3) Use of hospital or CAH facilities.

(4) Medical social services.

(5) Drugs, biologicals, supplies, appliances, and equipment.

(6) Certain other diagnostic or therapeutic services.

(7) Medical or surgical services provided by certain interns or residents-in-training.

(8) Transportation services, including transport by ambulance.

(b) Inpatient hospital services does not include the following types of services:

(1) Posthospital SNF care, as described in § 409.20, furnished by a hospital or a critical access hospital that has a swing-bed approval.

(2) Nursing facility services, described in § 440.155 of this chapter, that may be furnished as a Medicaid service under title XIX of the Act in a swing-bed hospital that has an approval to furnish nursing facility services.

(3) Physician services that meet the requirements of § 415.102(a) of this chapter for payment on a fee schedule basis.

(4) Physician assistant services, as defined in section 1861(s)(2)(K)(i) of the Act.

(5) Nurse practitioner and clinical nurse specialist services, as defined in section 1861(s)(2)(K)(ii) of the Act.

(6) Certified nurse mid-wife services, as defined in section 1861(gg) of the Act.

(7) Qualified psychologist services, as defined in section 1861(ii) of the Act.

(8) Services of an anesthetist, as defined in § 410.69

[48 FR 12541, Mar. 25, 1983, as amended at 50 FR 33033, Aug. 16, 1985; 58 FR 30666, May 26, 1993; 64 FR 3648, Jan. 25, 1999; 65 FR 18535, Apr. 7, 2000]
Notes of Decisions
Cited in 9 cases (1 in the last 5 years), 1988–2025 · leading case: USA, ex rel. v. UPMC
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USA, ex rel. v. UPMC (2019) ca3 · cites it 2× “42 C.F.R. §§ 409.10 (a), 411.351. A referral is a doctor’s request for a designated health ser- vice.”
United States ex rel. Simpson v. Bayer Corp. (2019) njd “§ 1395c ; 42 C.F.R. § 409.10 (a)(5). With certain exceptions not applicable here, Medicare reimburses hospitals for items and services provided to beneficiaries during inpatient stays "through fixed, bundled payments on a per discharge basis under the Inpatient Prospective…”
United States v. UPMC (2019) ca3 · cites it 2× “42 C.F.R. §§ 409.10 (a), 411.351. A referral is a doctor’s request for a designated health ser- vice.”
Clark Regional Medical Center Pattie A. Clay Hospital v. United States Department of Health and Human Services (2002) ca6 “§ 1395tt; 42 C.F.R. §§ 409.10 , 413.114 (1995). Congress recognized, however, that payment under PPS may not account for the added costs incurred by hospitals that treat a disproportionate number of low-income patients.”
Maryland Ass'n of Health Maintenance Organizations v. Health Services Cost Review Commission (1999) md “At the time this case was filed, “hospital services” were defined as: “(i) Inpatient hospital services as enumerated in Medicare Regulation 42 C.F.R. § 409.10 , as amended; (ii) Emergency services; (iii) Outpatient services provided at the hospital; and (iv) Identified physician…”
Dicioccio v. Chung (2017) paed “42 C.F.R. § 409.10 (a). . Ctrs. for Medicare & Medicaid Servs.”
Lopez v. Contra Costa Regional Medical Center (2012) cand “10(a) defines “inpatient hospital services” as including a broad range of services such as “[b]ed and board,” “[u]se of hospital .”
Hurley ex rel. Hurley v. Bowen (1988) ca2 “While post-acute care skilled nursing services provided in a hospital are generally not covered, 42 C.F.R. § 409.10 (b) (1987), Medicare does pay the costs of in-hospital skilled nursing care as long as the claimant’s physician certifies that the claimant required such care and…”
DUFFUS v. MAINEHEALTH (2025) med “1395x; 42 C.F.R. § 409.10 (2025). However, neither party here disputes that MMC admitted Mr.”
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