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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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...
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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 P...
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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
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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.
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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.
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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.
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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 INTR...
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Hospital Insurance (Part A)Jurisdiction over Appeals of Disproportionate Share Hospital (DSH) Payments, and Recalculations of DSH Payments Following Remands From Administrative Tribunals
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Changes in Medicare appeals procedures under section 521 of BIPA.
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Allocation of Donor Acquisition Costs Incurred by Organ Procurement Organizations (OPOs)
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Hospital Insurance (Part A). INTERPRETATION OF MEDICAID DAYS INCLUDED IN THE MEDICARE DISPROPORTIONATE SHARE ADJUSTMENT CALCULATION
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MEDICARE PROGRAM, Medicare Supplemental Medical Insurance (Part B), PHASE-IN OF CORRECTION TO PAYMENT LOCALITY ASSIGNMENT FOR AUSTIN COUNTY AND HOUSTON COUNTY TEXAS
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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 Vis...
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Medicare Supplementary Medical Insurance (Part B)
CLARIFICATION OF THE TERMS "ORTHOTICS," "BRACES," AND "DURABLE MEDICAL EQUIPMENT" UNDER MEDICARE PART B
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Hospice Appeals for Review of an Overpayment Determination
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Medicare Hospital Insurance (Part A) and Medicare Supplementary Medical Insurance (Part B) CLARIFICATION OF BILLING UNDER MEDICARE PARTS A AND B
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Implementing United States v. Windsor for Purposes of Entitlement and Enrollment in Medicare Hospital Insurance and Supplementary Medical Insurance
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Hospital Insurance (Part A); Appeals of Disproportionate Share Hospital (DSH) Payments, Recalculations of DSH Payments Following Remands from Administrative Tribunals, and Amendment of CMS Ruling 1498-R
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Classification of Therapeutic Continuous Glucose Monitors as ?Durable Medical Equipment? under Medicare Part B
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Hospital Insurance (Part A) Jurisdiction of the Provider Reimbursement Review Board and Other Administrative Appeals Tribunals Over Appeals of Specific Matters that are Subject to a Payment Regulation or Policy that Gives the Medicare Contractor No Author...
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Payment for Laboratory Tests for the detection of SARS–CoV–2 or the diagnosis of the virus that causes COVID–19 making use of the technologies marketed as the Roche cobas ® analyzer or the Abbott RealTime System® as of April 13, 2020
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Hospital Insurance (Part A); Jurisdiction over Appeals of Disproportionate Share Hospital Payments Involving Challenges to the Treatment of Part C Days in the SSI and Medicaid Fractions for Cost Reports With Discharges before October 1, 2013.
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Lab Administrative Ruling
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Reasonable Costs-Related Part Supplier -Burden of Proof
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Provider Reimbursement—Related Organizations—Inclusion in Allowable Costs of Payments Made Pursuant to Lease and Management Agreements
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Provider Reimbursement Review Board Decision on the Lack of Jurisdiction
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USE OF STATISTICAL SAMPLING TO PROJECT OVERPAYMENTS TO MEDICARE PROVIDERS AND SUPPLIERS
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WEIGHT TO BE GIVEN TO A TREATING PHYSICIAN'S OPINION IN DETERMINING MEDICARE COVERAGE OF INPATIENT CARE IN A HOSPITAL OR SKILLED NURSING FACILITY
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Medicare Part B and Part C Reimbursement Claims for Continuous Glucose Monitors (CGMs)
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