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 D—To Whom Payment Is Ordinarily Made

42 C.F.R. § 424.51

Payment to the provider

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(a) Basic rule. Except as specified in paragraph (b) of this section, Medicare pays the provider for services furnished by a provider.

(b) Exception. Medicare pays the beneficiary for outpatient hospital services if the hospital has collected an amount in excess of the unmet deductible and coinsurance, as specified in § 489.30(b)(4) of this chapter.

Notes of Decisions
Cited in 3 cases (1 in the last 5 years), 2003–2025 · leading case: Atlanticare Med. Ctr. v. Comm'r of the Div. of Med. Assistance, 439 Mass. 1 (Mass. 2003).
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Atlanticare Med. Ctr. v. Comm'r of the Div. of Med. Assistance, 439 Mass. 1 (Mass. 2003). “146 (2000) (individual’s assignment to State of rights to benefits “may not include assignment of rights to Medicare benefits”); 42 C.F.R. § 424.51 (2001) (basic rule that “Medicare pays the provider for services by a provider”).”
Willowood of Great Barrington, Inc. v. Sebelius, 638 F. Supp. 2d 98 (D. Mass. 2009). “42 C.F.R. § 424.51 (a); Medicare Claims Processing Manual, ch.”
Medica Ins. Co. v. Becerra (D.D.C. 2025). “§§ 1395g, 1395l; 42 C.F.R. §§ 424.51 , 424.55. But rather than filing a claim with Medicare directly, the supplier files a claim with an intermediary, known as a Medicare Administrative Contractor or “carrier.”
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