Medicare Statutes

Social Security Act Title XVIII 

Health Insurance for the Aged and Disabled

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Medicare A Hospital & B Doctor Visits


Technical Codes


Part A—Hospital Insurance Benefits
for the Aged and Disabled

Sec. 1811. Description of program

Sec. 1812. Scope of benefits

Sec. 1813. Deductibles and coinsurance

Sec. 1814. Conditions of and limitations on payment for services

Sec. 1815. Payment to providers of services

Sec. 1816. Provisions relating to the administration of Part A

Sec. 1817. Federal hospital insurance trust fund

Sec. 1818. Hospital insurance benefits for uninsured elderly individuals not otherwise eligible

Sec. 1818A. Hospital insurance benefits for disabled individuals who have exhausted other entitlement

Sec. 1819. Requirements for, and assuring quality of care in, skilled nursing facilities

Sec. 1820. Medicare rural hospital flexibility program

Sec. 1821. Conditions for coverage of religious nonmedical health care institutional services

Part B—Supplementary Medical – Doctor Visits
Insurance Benefits for the Aged and Disabled

Sec. 1831. Establishment of supplementary medical insurance program for the aged and the disabled

Sec. 1832. Scope of benefits

Sec. 1833. Payment of benefits

Sec. 1834. Special payment rules for particular items and services


Sec. 1835. Procedure for payment of claims of providers of services

Sec. 1836. Eligible individuals

Sec. 1837. Enrollment periods

Sec. 1838. Coverage period

Sec. 1839. Amounts of premiums

Sec. 1840. Payment of premiums

Sec. 1841. Federal supplementary medical insurance trust fund

Sec. 1842. Provisions relating to the administration of Part B

Sec. 1843. State agreements for coverage of eligible individuals who are receiving money payments under public assistance programs or are eligible for medical assistance Sec. 1844. Appropriations to cover Government contributions and contingency reserve

[Sec. 1845. Repealed.]

Sec. 1846. Intermediate sanctions for providers or suppliers of clinical diagnostic laboratory tests

Sec. 1847. Competitive acquisition of certain items and services

Sec. 1847A. Use of average sales price payment methodology

Sec. 1847B. Competitive acquisition of outpatient drugs and biologicals

Sec. 1848. Payment for physicians’ services

Medicare Advantage

Sec. 1851. Eligibility, election, and enrollment

Sec. 1852. Benefits and beneficiary protections

Sec. 1853. Payments to Medicare+Choice organizations

Sec. 1854. Premiums and Premium Amounts

Sec. 1855. Organizational and financial requirements for Medicare+Choice organizations; provider–sponsored organizations

Sec. 1856. Establishment of standards

Sec. 1857. Contracts with Medicare+Choice organizations

Sec. 1858. Special Rules for MA Regional Plans

Sec. 1859. Definitions; miscellaneous provisions

Part D—Voluntary Prescription Drug Benefit Program

Subpart 1—Part D Eligible Individuals and Prescription Drug Benefits

Sec. 1860D-1. Eligibility, enrollment, and information

Sec. 1860D-2. Prescription drug benefits

Sec. 1860D-3. Access to a choice of qualified prescription drug coverage

Sec. 1860D-4. Beneficiary protections for qualified prescription drug coverage

Subpart 2—Prescription Drug Plans; PDP Sponsors; Financing

Sec. 1860D-11. PDP regions; submission of bids; plan approval

Sec. 1860D-12. Requirements for and contracts with prescription drug plan (PDP) sponsors

Sec. 1860D-13. Premiums; late enrollment penalty

Sec. 1860D-14. Premium and cost-sharing subsidies for low-income individuals

Sec. 1860D-14A. Medicare coverage gap discount program

Sec. 1860D-15. Subsidies for Part D eligible individuals for qualified prescription drug coverage

Sec. 1860D-16. Medicare prescription drug account in the federal supplementary medical insurance trust fund

Subpart 3—Application to Medicare Advantage Program and Treatment of Employer-Sponsored Programs and Other Prescription Drug Plans

Sec. 1860D-21. Application to medicare advantage program and related managed care programs

Sec. 1860D-22. Special rules for employer-sponsored programs

Sec. 1860D-23. State pharmaceutical assistance programs

Sec. 1860D-24. Coordination requirements for plans providing prescription drug coverage

Subpart 4—Medicare Prescription Drug Discount Card and Transitional Assistance Program

Sec. 1860D-31. Medicare prescription drug discount card and transitional assistance program

Subpart 5—Definitions and Miscellaneous Provisions

Sec. 1860D-41. Definitions; treatment of references to provisions in Part C

Sec. 1860D-42. Miscellaneous provisions

Sec. 1860D-43 . Condition for Coverage of Drugs Under This Part

Part E—Miscellaneous Provisions

Sec. 1861. Definitions of services, institutions, etc.

Sec. 1862. Exclusions from coverage and medicare as secondary payer

Sec. 1863. Consultation with State agencies and other organizations to develop conditions of participation for providers of services

Sec. 1864. Use of State agencies to determine compliance by providers of services with conditions of participation

Sec. 1865. Effect of accreditation

Sec. 1866. Agreements with providers of services; enrollment processes

Sec. 1866A. Demonstration of application of physician volume increases to group practices

Sec. 1866B. Provisions for administration of demonstration program

Sec. 1866C. Health care quality demonstration program

Sec. 1866D. National pilot program on payment bundling

Sec. 1866E. Independence at home medical practice demonstration program

Sec. 1867. Examination and treatment for emergency medical conditions and women in labor

Sec. 1868. Practicing physicians advisory council; council for technology and innovation

Sec. 1869. Determinations; Appeals

Sec. 1870. Overpayment on behalf of individuals and settlement of claims for benefits on behalf of deceased individuals

Sec. 1871. Regulations

Sec. 1872. Application of certain provisions of Title II

Sec. 1873. Designation of organization or publication by name

Sec. 1874. Administration

Sec. 1874A. Contracts with medicare administrative contractors

Sec. 1875. Studies and recommendations

Sec. 1876. Payments to health maintenance organizations and competitive medical plans

Sec. 1877. Limitation on certain physician referrals

Sec. 1878. Provider reimbursement review board

Sec. 1879. Limitation on liability of beneficiary where medicare claims are disallowed

Sec. 1880. Indian health service facilities

Sec. 1881. Medicare coverage for end stage renal disease patients

Sec. 1881A. Medicare coverage for individuals exposed to environmental health hazards

Sec. 1882. Certification of medicare supplemental health insurance policies

Sec. 1883. Hospital providers of extended care services

Sec. 1884. Payments to promote closing and conversion of underutilized hospital facilities

Sec. 1885. Withholding of payments for certain medicaid providers

Sec. 1886. Payment to hospitals for inpatient hospital services

Sec. 1887. Payment of provider–based physicians and payment under certain percentage arrangements

Sec. 1888. Payment to skilled nursing facilities for routine service costs

Sec. 1889. Provider education and technical assistance

Sec. 1890. Contract with a consensus-based entity regarding performance measurement

Sec. 1890A. Quality and efficiency measurement

Sec. 1891. Conditions of participation for home health agencies; Home health quality

Sec. 1892. Offset of payments to individuals to collect past-due obligations arising from breach of scholarship and loan contract

Sec. 1893. Medicare integrity program

Sec. 1894. Payments to, and coverage of benefits under, programs of all–inclusive care for the elderly (PACE)

Sec. 1895. Prospective payment for home health services

Sec. 1896. Medicare subvention for military retirees

Sec. 1897. Health care infrastructure improvement program

Sec. 1898. medicare improvement fund

Sec. 1899. Shared savings program

Sec. 1899A. Independent medicare advisory board.

Sec. 1899B. Standardized Post-Acute Care (PAC) Assesment Data for Quality, Payment, and Discharge Planning

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