Audience:

DO/BO/TSC:
CR, CR TII, DRT, FR, OA, OS, RR, SR
OCO-OIO:
CA, CATA, EIE, FCR
PSC:
CRTA, CS, IES, RECONR

Citations:

Act—Sec. 1862

Regs. No. 5—Secs. 405.310-405.320

HI 00620.001 General Exclusions

No payment can be made under either the hospital insurance or SMI program for certain items and services:

  1. Not reasonable and necessary (HI 00620.010);

  2. No legal obligation to pay or provide services (HI 00620.020);

  3. Paid for by a governmental entity (HI 00620.030);

  4. Not provided within the United States (HI 00620.080);

  5. Resulting from war (HI 00620.090);

  6. Personal comfort (HI 00620.100);

  7. Routine services and appliances (HI 00620.110);

  8. Supportive devices for feet (HI 00620.120);

  9. Custodial care (HI 00620.130);

  10. Cosmetic surgery (HI 00620.140);

  11. Charges by immediate relatives or members of household (HI 00620.150);

  12. Dental services (HI 00620.160);

  13. Paid or expected to be paid under workers' compensation (HI 00620.170);

  14. Paid or expected to be paid under automobile medical or no-fault insurance or paid under liability insurance (HI 00620.175);

  15. Covered by employer plans for end-stage renal disease beneficiaries and beneficiaries age 65-69 (working aged) and their spouses age 65-69 (HI 00620.177);

  16. Excluded foot care (HI 00620.180);

  17. Application of foot care exclusion to physicians' services(HI 00620.190)

  18. Exclusions of refractive services (HI 00620.200).


To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0600620001
HI 00620.001 - General Exclusions - 03/11/1999
Batch run: 01/27/2009
Rev:03/11/1999