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CMS Rulings

CMS Rulings are decisions of the Administrator that serve as precedent final opinions and orders and statements of policy and interpretation. They provide clarification and interpretation of complex or ambiguous provisions of the law or regulations relating to Medicare, Medicaid, Utilization and Quality Control Peer Review, private health insurance, and related matters.

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CMS Ruling 05-01 Requirements for Determining Coverage of Presbyopia-Correcting Intraocular Lenses that Provide Two Distinct Services for the Patient: (1) Restoration of Distance Vision Following Cataract Surgery, and (2) Refractive Correction of Near and Intermediate Vision with Less Dependency on Eyeglasses or Contact Lenses
HCFA Ruling 95-1 Hospital Insurance (Part A) and Supplementary Medical Insurance (Part B) REQUIREMENTS FOR DETERMINING LIMITATION ON LIABILITY OF A MEDICARE BENEFICIARY, PROVIDER, PRACTITIONER, OR OTHER SUPPLIER FOR CERTAIN SERVICES AND ITEMS FOR WHICH MEDICARE PAYMENT IS DENIED.
HCFA Ruling 96-1 Medicare Supplementary Medical Insurance (Part B) CLARIFICATION OF THE TERMS "ORTHOTICS," "BRACES," AND "DURABLE MEDICAL EQUIPMENT" UNDER MEDICARE PART B
HCFA Ruling 96-2 Hospital Insurance (Part A) and Supplementary Medical Insurance (Part B) REQUIREMENTS FOR DETERMINING LIMITATION ON LIABILITY OF A MEDICARE BENEFICIARY, SUPPLIER, PRACTITIONER, OR OTHER SUPPLIER FOR PAP SMEARS AND MAMMOGRAPHY SERVICES FOR WHICH MEDICARE PAYMENT IS DENIED.
HCFA Ruling 97-2 Hospital Insurance (Part A). INTERPRETATION OF MEDICAID DAYS INCLUDED IN THE MEDICARE DISPROPORTIONATE SHARE ADJUSTMENT CALCULATION
HCFA Ruling 98-1 Medicare Supplementary Medical Insurance (Part B) THE ADMINISTRATIVE APPEALS PROCESS FOR PHYSICIANS, NON-PHYSICIAN PRACTITIONERS, AND ENTITIES THAT RECEIVE REASSIGNED BENEFITS AND THAT ARE NOT PROVIDED APPEAL RIGHTS UNDER 42 CFR PART 498
HCFA Ruling 96-3 Hospital Insurance (Part A) and Supplementary Medical Insurance (Part B) REQUIREMENTS FOR DETERMINING LIMITATION ON LIABILITY OF A MEDICARE BENEFICIARY, PROVIDER, PRACTITIONER, OR OTHER SUPPLIER FOR PARENTERAL AND ENTERAL NUTRITION THERAPY, INCLUDING INTRADIALYTIC PARENTERAL NUTRITION THERAPY, SERVICES AND ITEMS FOR WHICH MEDICARE PAYMENT IS DENIED.
CMS Ruling 01-01 The National and Local Coverage Determination Review Process for an Individual with Standing as Defined in Section 522 of the Medicare, Medicaid, and SCHIP Benefits Improvement and Protections Act of 2000.
CMS Ruling 02-01 Changes in Medicare appeals procedures under section 521 of BIPA.
HCFA Ruling 97-1 Requirements for determining limitation on liability of a medicare beneficiary, provider, practitioner, or other supplier for partial hospitalization services for which Medicare payment is denied.
CMS-1543-R Allocation of Donor Acquisition Costs Incurred by Organ Procurement Organizations (OPOs)
CMS-1536-R This Ruling sets forth the policy of the CMS concerning the requirements for determining payment made for insertion of astigmatism-conecting intraocular lenses following cataract surgery under the following sections of the Act.
CMS-1498-R Hospital Insurance (Part A)Jurisdiction over Appeals of Disproportionate Share Hospital (DSH) Payments, and Recalculations of DSH Payments Following Remands From Administrative Tribunals
CMS-1355-R Hospice Appeals for Review of an Overpayment Determination
CMS-1423-R MEDICARE PROGRAM, Medicare Supplemental Medical Insurance (Part B), PHASE-IN OF CORRECTION TO PAYMENT LOCALITY ASSIGNMENT FOR AUSTIN COUNTY AND HOUSTON COUNTY TEXAS
CMS-1455-R Medicare Hospital Insurance (Part A) and Medicare Supplementary Medical Insurance (Part B) CLARIFICATION OF BILLING UNDER MEDICARE PARTS A AND B