Search Frequenty Asked Questions

Normal Fonts Larger Fonts Printer Version Email this page Submit Feedback Questions & Answers About CMS Return to cms.hhs.gov Home Normal Fonts Larger Fonts Email this page Submit Feedback Questions & Answers About CMS Return to cms.hhs.gov Home
Return to cms.hhs.gov Home    Return to cms.hhs.gov Home

  


  Professionals   Governments   Consumers   Public Affairs

CMS Rulings

Centers for Medicare & Medicaid Services
Department of Health and Human Services

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.


CMS Ruling 02-01

(PDF-131 kb) dated October 2002

This CMS Ruling sets forth our policy regarding implementation of the new appeals provisions in section 1869 of the Social Security Act, as amended by section 521 of the Medicare, Medicaid and SCHIP Benefits Improvement and Protection Act of 2000 (BIPA), Public Law 106-554. The Ruling identifies changes that take effect on October 1, 2002 and provides notice of the administrative procedures that CMS contractors, administrative law judges, and the Departmental Appeals Board are to follow in processing Medicare claims appeals.

Ruling 01-01

dated September 2001

This Ruling states the CMS policy regarding the appropriate actions upon receipt of a complaint seeking review of a national or local coverage determination under section 522 of the Medicare, Medicaid, and SCHIP Benefits Improvement and Protection Act of 2000 (BIPA), Public Law 106-554.

HCFA Ruling 98-1

dated December 1998

This Ruling states the policy of the Health Care Financing Administration regarding the appropriate administrative appeals process the Medicare carrier must provide to physicians, non-physician practitioners, and to certain entities that receive reassigned benefits from physicians and non-physician practitioners. This appeals process will be available to a physician or entity that (i) has received reassigned benefits; (ii) has been denied enrollment in the Medicare program or had Medicare billing privileges revoked; and (iii) is not eligible to use the appeals procedures in 42 CFR part 498.

HCFA Ruling 97-2

dated February 1997

This Ruling states the policy of the Health Care Financing Administration concerning the determination to change its interpretation of section 1886(d)(5)(F)(vi)(II) of the Social Security Act (the Act) and 42 CFR 412.106(B)(4) to follow the holdings of the United States Courts of Appeals for the Fourth, Sixth, Eighth, and Ninth Circuits. Under the new interpretation, the Medicare disproportionate share adjustment under the hospital inpatient prospective payment system will be calculated to include all inpatient hospital days of service for patients who were eligible on that day for medical assistance under a State Medicaid plan in the Medicaid fraction, whether or not the hospital received payment for those inpatient hospital services.

HCFA Ruling 97-1

dated February 1997

This Ruling states the policy of the Health Care Financing Administration concerning the requirements for determining if Medicare payment will be made under the limitation on liability provision, section 1879 of the Social Security Act, to a provider, practitioner, or other supplier for partial hospitalization services for which Medicare payment is denied.

HCFA Ruling 96-3

dated December 1996

This Ruling states the existing policy of the Health Care Financing Administration concerning the requirements for determining if Medicare payment will be made under the limitation on liability provision, section 1879 of the Social Security Act, to a 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. This Ruling supplements HCFAR 95-1 with respect to section 1879(g) of the Act.

HCFA Ruling 96-2

dated November 1996

This Ruling states the policy of the Health Care Financing Administration concerning the requirements for determining if Medicare payment will be made under the limitation on liability provision, section 1879 of the Social Security Act, to a supplier, practitioner, or other supplier for pap smears and mammography services for which Medicare payment is denied.

HCFA Ruling 96-1

dated September 1996

This Ruling states the policy of the Health Care Financing Administration regarding the distinction between the statutory benefits of "orthotics" and "durable medical equipment" under Medicare Part B. The distinction may have an effect on the Medicare approved amount of payment and is necessary in those instances where items are furnished in skilled nursing facilities that meet the definition in section 1819(a)(1) of the Social Security Act (the Act) or hospitals due to the express exclusion from Part B coverage of durable medical equipment when used in a hospital or skilled nursing facility.

The Ruling clarifies that the "orthotics" benefit in section 1861(s)(9) of the Act, insofar as braces are concerned, is limited to leg, arm, back, and neck braces that are used independently rather than in conjunction with, or as components of, other medical or non-medical equipment. It also clarifies that accessories used in conjunction with, and necessary for the full functioning of, durable medical equipment fall under the durable medical equipment benefits category. Finally, the Ruling provides several examples that illustrate the application and scope of these two terms.

HCFA Ruling 95-1

dated December 1995

This Ruling states the policy of the Health Care Financing Administration concerning the requirements for determining if Medicare payment will be made under the limitation on liability provisions, section 1879 of the Social Security Act, to a provider, practitioner, or other supplier for certain services and items for which Medicare payment is denied.


Return Arrow  Return to the Laws and Regulations Home Page

View the latest actions CMS has taken to implement
The Medicare Prescription Drug, Improvement and Modernization Act of 2003

View and/or send email comments on CMS regulations with an open comment period published beginning January 30, 2004.

View CMS regulations with an open comment period published before January 30, 2004, at Regulations.gov.

Last Modified on Thursday, September 16, 2004