42 CFR 424.124 - Conditions for payment for physician services and ambulance services.

§ 424.124 Conditions for payment for physician services and ambulance services.

(a)Basic rules. Medicare Part B pays for physician and ambulance services if -

(1) They are furnished -

(i) To an individual who is entitled to Part B benefits; and

(ii) In connection with covered inpatient hospital services; and

(2) They meet the conditions set forth in paragraphs (b) and (c) of this section.

(b)Physician services.

(1) The physician services are services covered under Medicare Part B and are furnished -

(i) In the hospital, during a period of covered inpatient services; or

(ii) Outside the hospital, on the day of admission and for the same condition that required inpatient admission; and

(2) The physician is legally authorized to practice in the country where he or she furnishes the services.

(c)Ambulance services. The ambulance services are -

(1) Necessary because the use of other means of transportation is contraindicated by the beneficiary's condition; and

(2) Furnished by an ambulance that meets the definition in § 410.41 of this chapter.

[ 53 FR 6646, Mar. 2, 1988; 53 FR 12945, Apr. 20, 1988; 64 FR 3649, Jan. 25, 1999]

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