Tuesday, April 23, 2019

Quality to the Next Level


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Noncovered Items and Services

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1-1008513825 - Monday, May 6, 2013

Rationale for the Referral: Pursuant to § 1861(s)(2)(zz) of the Social Security Act, Medicare covers intravenous immune globulin (IVIG) in the home only when used to treat a diagnosed primary immune deficiency disease.

Referral Document

Appeals Council Decision

 
1-991173814 - Monday, May 6, 2013

Rationale for the Referral: Part B Medicare does not cover the antibiotic drug Ceftriaxone and related supplies for administration in the home because antibiotic drugs and disposable supplies furnished for home use do not fall under a covered benefit category.

Referral Document

Appeals Council Decision

 
1-848099792 - Friday, February 22, 2013

Rationale for the Referral: The statutory requirements for payment of inpatient hospital services furnished to a beneficiary who was “within Canada while traveling without unreasonable delay by the most direct route … between Alaska and another state” are not satisfied when the beneficiary makes detours unrelated to the purpose of reaching his or her destination, such as work related detours.

Referral Document

Appeals Council Decision

 
1-907771471 - Friday, February 22, 2013
Rationale for the Referral: Absent covered inpatient hospital care, ambulance services and physician services furnished outside of the United States are excluded from coverage under section 1814(f) of the Social Security Act. Further, Medicare does not pay for any other Part B medical and other health services, including outpatient services furnished outside of the United States. Pursuant to 42 CFR Section 410.40(f), Medicare only covers ambulance transportation to a foreign hospital in conjunction with the beneficiary’s admission for medically necessary inpatient services.

Referral Document

Appeals Council Decision


 
1-828681071 - Tuesday, June 5, 2012
Rationale for the Referral: Section 1862(a)(7) of the Social Security Act and 42 C.F.R. § 411.15(d) exclude from Medicare coverage hearing aids and examinations for the purpose of prescribing, fitting or changing hearing aids.

Referral Document

Appeals Council Decision

 
  
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