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 H—Payment of Hospital Insurance Benefits

42 C.F.R. § 409.100

To whom payment is made

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(a) Basic rule. Except as provided in paragraph (b) of this section—

(1) Medicare pays hospital insurance benefits only to a participating provider.

(2) For home health services (including medical supplies described in section 1861(m)(5) of the Act, but excluding durable medical equipment to the extent provided for in such section) furnished to an individual who at the time the item or service is furnished is under a plan of care of an HHA, payment is made to the HHA (without regard to whether the item or service is furnished by the HHA directly, under arrangement with the HHA, or under any other contracting or consulting arrangement).

(b) Exceptions. Medicare may pay hospital insurance benefits as follows:

(1) For emergency services furnished by a nonparticipating hospital, to the hospital or to the beneficiary, under the conditions prescribed in subpart G of part 424 of this chapter.

(2) For services furnished by a Canadian or Mexican hospital, to the hospital or to the beneficiary, under the conditions prescribed in subpart H of part 424 of this chapter.

[53 FR 6633, Mar. 2, 1988, as amended at 65 FR 41211, July 3, 2000]
Notes of Decisions
Cited in 1 case (1 in the last 5 years), 2021–2021 · leading case: Cooper Hosp. Univ. Med. Ctr. v. Selective Ins. Co. of Am. (085211) (Camden Cnty. & Statewide) (N.J. 2021).
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Cooper Hosp. Univ. Med. Ctr. v. Selective Ins. Co. of Am. (085211) (Camden Cnty. & Statewide) (N.J. 2021). · cites it 2× “Federal regulations dictate that “Medicare pays hospital insurance benefits only to a participating provider,” 42 C.F.R. § 409.100 (a)(1), and define “participating” as “a hospital or other facility that meets the conditions of 10 We note that DHHS allows “[a] patient on…”
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