C.F.R. » Title 42 » CHAPTER IV—CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES › SUBCHAPTER B—MEDICARE PROGRAM › PART 424—CONDITIONS FOR MEDICARE PAYMENT › Subpart A—General Provisions

42 C.F.R. § 424.3

Definitions

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As used in this part, unless the context indicates otherwise—

HCPCS means Healthcare Common Procedure Coding System.

ICD-9-CM means International Classification of Diseases, Ninth Revision, Clinical Modification.

Nonparticipating hospital means a hospital that does not have in effect a provider agreement to participate in Medicare.

Participating hospital means a hospital that has in effect a provider agreement to participate in Medicare.

[53 FR 6634, Mar. 2, 1988, as amended at 59 FR 10299, Mar. 4, 1994; 63 FR 26311, May 12, 1998; 70 FR 45055, Aug. 4, 2005]
Notes of Decisions
Cited in 2 cases, 2006–2012 · leading case: United States Ex Rel. Sikkenga v. Regence Bluecross Blueshield, 472 F.3d 702 (10th Cir. 2006).
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United States Ex Rel. Sikkenga v. Regence Bluecross Blueshield, 472 F.3d 702 (10th Cir. 2006). · cites it 2× “See 42 C.F.R. §§ 424.3 , 424.32. -10- Sikkenga also suspected that ARUP falsely submitted various ICD-9 codes related to renal failure in connection with CPT code 86317, a code suggesting that the patient was involved in a kidney transplant, a procedure that should have been…”
United States v. Kernan Hosp., 880 F. Supp. 2d 676 (D. Maryland 2012). “See 42 C.F.R. §§ 424.3 , 424.32. In 2005, the HSCRC instituted a new reporting program for hospitals permitting the inclusion of secondary diagnoses.”
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