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 C—Claims for Payment

42 C.F.R. § 424.44

Time limits for filing claims

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(a) Time limits. (1) Except as provided in paragraphs (b) and (e) of this section, for services furnished on or after January 1, 2010, the claim must be filed no later than the close of the period ending 1 calendar year after the date of service.

(2) Except as provided in paragraphs (b) and (e) of this section and except for services furnished during the last 3 months of 2009, for services furnished before January 1, 2010, the claim must be filed—

(i) On or before December 31 of the following year for services that were furnished during the first 9 months of a calendar year; and

(ii) On or before December 31st of the second following year for services that were furnished during the last 3 months of the calendar year.

(3) For services furnished during the last 3 months of CY 2009 all claims must be filed no later than December 31, 2010.

(b) Exceptions to time limits. Exceptions to the time limits for filing claims include the following:

(1) The time for filing a claim will be extended if CMS or one of its contractors determines that a failure to meet the deadline in paragraph (a) of this section was caused by error or misrepresentation of an employee, Medicare contractor (including Medicare Administrative Contractor, intermediary, or carrier), or agent of HHS that was performing Medicare functions and acting within the scope of its authority.

(2) The time for filing a claim will be extended if CMS or one of its contractors determines that a failure to meet the deadline in paragraph (a) of this section is caused by all of the following conditions:

(i) At the time the service was furnished the beneficiary was not entitled to Medicare.

(ii) The beneficiary subsequently received notification of Medicare entitlement effective retroactively to or before the date of the furnished service.

(3) The time for filing a claim will be extended if CMS or one of its contractors determines that a failure to meet the deadline in paragraph (a) of this section is caused by all of the following conditions:

(i) At the time the service was furnished the beneficiary was not entitled to Medicare.

(ii) The beneficiary subsequently received notification of Medicare entitlement effective retroactively to or before the date of the furnished service.

(iii) A State Medicaid agency recovered the Medicaid payment for the furnished service from a provider or supplier 6 months or more after the service was furnished.

(4) The time for filing a claim will be extended if CMS or one of its contractors determines that a failure to meet the deadline in paragraph (a) of this section is caused by all of the following conditions:

(i) At the time the service was furnished the beneficiary was enrolled in a Medicare Advantage plan or Program of All-inclusive Care for the Elderly (PACE) provider organization.

(ii) The beneficiary was subsequently disenrolled from the Medicare Advantage plan or Program of All-inclusive Care for the Elderly (PACE) provider organization effective retroactively to or before the date of the furnished service.

(iii) The Medicare Advantage plan or Program of All-inclusive Care for the Elderly (PACE) provider organization recovered its payment for the furnished service from a provider or supplier 6 months or more after the service was furnished.

(5) Extension of time. (i) If CMS or one of its contractors determines that a failure to meet the deadline specified in paragraph (a) of this section was caused by error or misrepresentation of an employee, Medicare contractor (including Medicare Administrative Contractor, intermediary, or carrier), or agent of HHS that was performing Medicare functions and acting within the scope of its authority, the time to file a claim will be extended through the last day of the sixth calendar month following the month in which either the beneficiary or the provider or supplier received notification that the error or misrepresentation referenced in paragraph (b)(1) of this section was corrected. No extension of time will be granted for paragraph (b)(1) when the request for that exception is made to CMS or one of its contractors more than 4 years after the date of service.

(ii) If CMS or one of its contractors determines that both of the conditions are met in paragraph (b)(2) of this section but that all of the conditions in paragraph (b)(3) are not satisfied, the time to file a claim will be extended through the last day of the sixth calendar month following the month in which either the beneficiary or the provider or supplier received notification of Medicare entitlement effective retroactively to or before the date of the furnished service.

(iii) If CMS or one of its contractors determines that all of the conditions are met in paragraph (b)(3) of this section, the time to file a claim will be extended through the last day of the sixth calendar month following the month in which the State Medicaid agency recovered the Medicaid payment for the furnished service from the provider or supplier.

(iv) If CMS or one of its contractors determines that all of the conditions are met in paragraph (b)(4) of this section, the time to file a claim will be extended through the last day of the sixth calendar month following the month in which the Medicare Advantage plan or Program of All-inclusive Care for the Elderly (PACE) provider organization recovered its payment for the furnished service from the provider or supplier.

(c) Extension of period ending on a nonworkday. If the last day of the period allowed under paragraph (a) or (b) of this section falls on a Federal nonworkday (a Saturday, Sunday, legal holiday, or a day which by statute or Executive Order is declared to be a nonworkday for Federal employees), the time is extended to the next succeeding workday.

(d) Outpatient diabetes self-management training. CMS makes payment in half-hour increments to an entity for the furnishing of outpatient diabetes self-management training on or after the approval date CMS approves the entity to furnish the services under part 410, subpart H of this chapter.

(e) As specified in §§ 424.520 and 424.521 of this subpart, there are restrictions on the ability of the following newly-enrolled suppliers to submit claims for items or services furnished prior to the effective date of their Medicare billing privileges:

(1) Physician or nonphysician practitioner organizations.

(2) Physicians.

(3) Nonphysician practitioners.

(4) Independent diagnostic testing facilities.

[53 FR 6634, Mar. 2, 1988, as amended at 65 FR 83153, Dec. 29, 2000; 73 FR 69939, Nov. 19, 2008; 75 FR 73627, Nov. 29, 2010]
Notes of Decisions
Cited in 18 cases (3 in the last 5 years), 2004–2024 · leading case: Loma Linda Univ. Med. Ctr. v. Sebelius, 684 F. Supp. 2d 42 (D.D.C. 2010).
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Loma Linda Univ. Med. Ctr. v. Sebelius, 684 F. Supp. 2d 42 (D.D.C. 2010). · cites it 8× “32 and 42 C.F.R. § 424.44 . 42 C.F.R. § 424.32 requires hospitals to submit claims for payment via a specific form, the Uniform Institutional Provider Bill, also called CMS-1450 or UB-92.”
United States Ex Rel. Prather v. Brookdale Senior Living Communities, Inc., 838 F.3d 750 (6th Cir. 2016). · cites it 4× “See 42 C.F.R. § 424.44 (a). And when the required face-to-face encounter between the doctor and patient occurs after the episode of care begins—it may occur “within 30 days of the start of the home health care,” 42 C.”
Hosp. of Univ. of Pennsylvania v. Sebelius, 634 F. Supp. 2d 9 (D.D.C. 2009). · cites it 6× “Plaintiffs have contended at every stage of the proceedings that even if they had notice of the claims filing requirements for the supplemental medical education payments, and even if the time limits from 42 C.F.R. § 424.44 apply, they have in fact satisfied those requirements…”
Cottage Health Sys. v. Sebelius, 631 F. Supp. 2d 80 (D.D.C. 2009). · cites it 4× “42 C.F.R. § 424.44 . Medicare part C was created by BBA '97.”
Hosp. of the Univ. of Pennsylvania v. Sebelius, 847 F. Supp. 2d 125 (D.D.C. 2012). · cites it 8× “Among the requirements are time limits for filing claims, which are codified at 42 C.F.R. § 424.44 : Basic limits.... [T]he claim must be mailed or delivered to the intermediary or carrier, as appropriate— (1) On or before December 31 of the following year for services that were…”
Visiting Nurse Serv. of New York Home Care v. New York State Dep't of Health, 840 N.E.2d 577 (NY 2005). “, a service provided during fiscal year 2000-2001 had to be submitted by December 31, 2002) (see 42 CFR 424.44 [a]). . The Appellate Division, Third Department, asked: “Did this Court err, as a matter of law, in affirming the judgment of Supreme Court, which partially granted…”
Karen Tucker v. Sec'y US Dep't of Hea, 487 F. App'x 52 (3rd Cir. 2012). “42 C.F. R. § 424.44 (effective to 12/31/08).”
Am. Hosp. Ass'n v. Sebelius, 68 F. Supp. 3d 54 (D.D.C. 2014). · cites it 3× “See 42 C.F.R. § 424.44 (b)(l)-(5). Plaintiffs do not argue that these specific enumerated exceptions apply to them; nor do they purport to challenge these particular regulations.”
Atlanticare Med. Ctr. v. Div. of Med. Assistance (Mass. 2020). · cites it 18× “See 42 C.F.R. § 424.44 (b)(3) (2019). In light of the First Circuit's holding and the amendment to 42 C.”
Laska v. Gen. Cas. Co., 2013 WI App 42 (Wis. Ct. App. 2013). “42 C.F.R. § 424.44 (a). Here, the billing period expired on December 31, 2008, several months before Laska settled his tort claims.”
Loma Linda Univ. Med. Ctr. v. Leavitt (D.D.C. 2010). · cites it 7× “32 and 42 C.F.R. § 424.44 . 42 C.F.R. § 424.32 requires hospitals to submit claims for payment via a specific form, the Uniform Institutional Provider Bill, also called CMS-1450 or UB-92.”
United States ex rel. Prather v. Brookdale Senior Living Communities, Inc., 265 F. Supp. 3d 782 (M.D. Tenn. 2017). “See 42 C.F.R. § 424.44 (a). In 2011 (the relevant time period .”
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