C.F.R. » Title 42 » CHAPTER IV—CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES › SUBCHAPTER B—MEDICARE PROGRAM › PART 410—SUPPLEMENTARY MEDICAL INSURANCE (SMI) BENEFITS › Subpart B—Medical and Other Health Services

42 C.F.R. § 410.58

Additional services to HMO and CMP enrollees

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Services not usually covered under Medicare Part B may be covered as medical and other health services if they are furnished to an enrollee of an HMO or a CMP and the following conditions are met:

(a) The services are—

(1) Furnished by a physician assistant or nurse practitioner as defined in § 491.2 of this chapter, or are incident to services furnished by such a practitioner; or

(2) Furnished by a clinical psychologist as defined in § 417.416 of this chapter to an enrollee of an HMO or CMP that participates in Medicare under a risk-sharing contract, or are incident to those services.

(b) The services are services that would be covered under Medicare Part B if they were furnished by a physician or as incident to a physician's professional services.

Notes of Decisions
Cited in 1 case, 2006–2006 · leading case: Martin v. Levitt, 205 F. App'x 611 (9th Cir. 2006).
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Martin v. Levitt, 205 F. App'x 611 (9th Cir. 2006). “Martin’s contention that the services were reimbursable under 42 C.F.R. § 410.58 is without merit because although the facts satisfy subsection (b), those services must be provided incident to a physician’s services under subsection (a) to be reimbursable.”
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