C.F.R. » Title 42 » CHAPTER IV—CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES › SUBCHAPTER B—MEDICARE PROGRAM › PART 414—PAYMENT FOR PART B MEDICAL AND OTHER HEALTH SERVICES › Subpart B—Physicians and Other Practitioners

42 C.F.R. § 414.40

Coding and ancillary policies

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(a) General rule. CMS establishes uniform national definitions of services, codes to represent services, and payment modifiers to the codes.

(b) Specific types of policies. CMS establishes uniform national ancillary policies necessary to implement the fee schedule for physician services. These include, but are not limited to, the following policies:

(1) Global surgery policy (for example, post- and pre-operative periods and services, and intra-operative services).

(2) Professional and technical components (for example, payment for services, such as an EEG, which typically comprise a technical component (the taking of the test) and a professional component (the interpretation)).

(3) Payment modifiers (for example, assistant-at-surgery, multiple surgery, bilateral surgery, split surgical global services, team surgery, and unusual services).

Notes of Decisions
Cited in 2 cases (1 in the last 5 years), 2002–2021 · leading case: US Ex Rel. Schuhardt v. Washington Univ., 228 F. Supp. 2d 1018 (E.D. Mo. 2002).
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US Ex Rel. Schuhardt v. Washington Univ., 228 F. Supp. 2d 1018 (E.D. Mo. 2002). “See 42 C.F.R. § 414.40 (b)(1); MCM § 4821.A. The global period for minor surgeries begins on the day of the procedure and continues, at most, for 10 days.”
Am. Clinical Lab'y Ass'n v. Azar (D.D.C. 2021). “See 42 C.F.R. § 414.40 (b)(2). 3 Citations to the Joint Appendix refer to the Bates numbers appearing at the bottom right of each page of the appendix.”
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