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 P—Requirements for Establishing and Maintaining Medicare Billing Privileges

42 C.F.R. § 424.521

Request for payment by certain provider and supplier types

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(a) Request for payment by certain provider and supplier types. (1) The providers and suppliers identified in paragraph (a)(2) of this section may retrospectively bill for services when the provider or supplier has met all program requirements (including State licensure requirements), and services were provided at the enrolled practice location for up to—

(i) Thirty days prior to their effective date if circumstances precluded enrollment in advance of providing services to Medicare beneficiaries; or

(ii) Ninety days prior to their effective date if a Presidentially-declared disaster under the Robert T. Stafford Disaster Relief and Emergency Assistance Act, 42 U.S.C. 5121-5206 (Stafford Act) precluded enrollment in advance of providing services to Medicare beneficiaries.

(2) The provider and supplier types to which paragraph (a)(1) of this section applies are as follows:

(i) Physicians.

(ii) Non-physician practitioners.

(iii) Physician organizations.

(iv) Non-physician practitioner organizations.

(v) Ambulance suppliers.

(vi) Opioid treatment programs.

(vii) Part B hospital departments.

(viii) Clinical Laboratory Improvement Amendment labs.

(ix) Intensive cardiac rehabilitation facilities.

(x) Mammography centers.

(xi) Mass immunizers/pharmacies.

(xii) Radiation therapy centers.

(xiii) Home infusion therapy suppliers.

(xiv) Physical therapists.

(xv) Occupational therapists.

(xvi) Speech language pathologists.

(b) [Reserved]

[79 FR 72531, Dec. 5, 2014, as amended at 84 FR 63203, Nov. 15, 2019; 85 FR 70355, Nov. 4, 2020; 86 FR 62419, Nov. 9, 2021]
Notes of Decisions
Cited in 3 cases (2 in the last 5 years), 2015–2024 · leading case: Willie Goffney, Jr. v. Xavier Becerra, 995 F.3d 737 (9th Cir. 2021).
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Willie Goffney, Jr. v. Xavier Becerra, 995 F.3d 737 (9th Cir. 2021). · cites it 2× “, 42 C.F.R. § 424.521 (a), HHS has not allowed that practice as a general matter, see Urology Grp.”
United States of Am. v. Healthcare Assocs. of Texas LLC (N.D. Tex. 2024). · cites it 4× “Shay and Gosfield state that 42 C.F.R. § 424.521 generally permits providers to bill Medicare for services rendered up to thirty days before their effective billing date, as long as Medicare ultimately approves their enrollment.”
Ramaswamy v. Burwell, 83 F. Supp. 3d 846 (E.D. Mo. 2015). “520 (d) and allowing 30 days of retrospective billing pursuant to 42 C.F.R. § 424.521 (a). . Ramaswamy has brought this case under § 405(g).”
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