CMS Rulings Issued Prior to 1995

CMS Rulings Issued Prior to 1995

Centers for Medicare & Medicaid Services (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.

CMS Rulings are binding on all CMS components, Medicare contractors, the Provider Reimbursement Review Board, the Medicare Geographic Classification Review Board, and Administrative Law Judges (ALJs) of the Social Security Administration (SSA) who hear Medicare appeals. These Rulings promote consistency in interpretation of policy and adjudication of disputes.

The CMS Rulings that were issued prior to 1995 can be found below. This list is searchable and sortable.  

All CMS Rulings issued in 1995 or after 1995 can be found on another section of CMS.gov: /Regulations-and-Guidance/Guidance/Rulings/CMS-Rulings.

Title Subject
Policy Regarding Medicare Payments in the Event a Primary Payer is Bankrupt or Insolvent
Weight to be Given to a Treating Physician's Opinion in Determining Medicare Coverage of Inpatient Care in a Hospital or Skilled Nursing Facility
Skilled Nursing Facility and Nursing Facility Provider Agreements
Notice of Decision to Follow a Consent Order Providing for the Discounted Application of the 1986 Medicare Malpractice Rule and a Reversion to the Pre-1979
Criteria for Medicare Coverage of Seat Lifts
Notice of Intent to Settle HMO and CMP Cost Reports for Periods Beginning on or After January 1 1986 Without Application of Absolute Cost Limits
Notice of Controlling Adverse Decisions by the Supreme Court and the DC Circuit Court of Appeals
Payments Under Medicare and Awards Under the Federal Tort Claims Act
Validity of Provider Reimbursement Manual Section 2345 Relating to the Inclusion of Labor-Delivery Room Days in the Calculation of Inpatient Days
Provider Reimbursement Review Board Jurisdiction Over Challenges to the Application or the Validity of the Medicare Regulation Governing Apportionment of Malpractice Insurance Costs
Criteria for Medicare Coverage of Heart Transplants
Provider Reimbursement Review Board Jurisdiction Over Challenges to the Application or the Validity of the Medicare Regulation Governing Apportionment of Malpractice Insurance Costs
Use of Statistical Sampling to Project Overpayments to Providers and Suppliers
Criteria for Medicare Coverage of Inpatient Hospital Rehabilitation Services
Exclusion of Cytotoxic Leukocyte Testing from Medicare Coverage
Provider Reimbursement Review Board Jurisdiction Over Appeals From Estimations of and Modifications to Base Year Costs Under the Prospective Payment System
Revised Criteria for Defining Skilled Nursing Facility When Determinging a Beneficiary's Spell of Illness Status
Criteria for Defining Skilled Nursing Facility Under Section 1861(j)(1) of the Social Security Act
Provider Reimbursement Review Board Decision on the Lack of Jurisdiction
Conditions for Medicare Coverage of Surgery to Relieve Obstructions to Vertebral Artery Blood Flow (Vertebral Artery Surgery)
Constitutionality of Part B Fair Hearing Procedures
Exclusion from Medicare Coverage of DMSO for Conditions Other Than Interstitial Cystitis
Page Last Modified:
09/06/2023 04:57 PM