HI 00620.080 Services Not Provided Within the United States
Items and services which are provided outside the United States are not covered except for certain services provided in Canadian and Mexican hospitals and physician services and ambulance services furnished in connection with such inpatient care. HI 01201.225-.285 contain information and instructions concerning the coverage of Canadian and Mexican services.
The term “United States” means the 50 States, the District of Columbia, the Commonwealth of Puerto Rico, the Virgin Islands, Guam, and American Samoa, and includes the territorial waters adjoining these entities. Generally speaking, the 3-mile limit off the shores of most of the United States constitutes American territory. In the case of Texas and Florida, the limit extends into the Gulf of Mexico within 9 miles (three leagues) off the shores of these States.
A hospital which is owned or operated by the U.S. Government does not constitute American territory if it is not located within one of the entities listed above. Similarly, a ship or aircraft, even of American registry, is not considered to constitute American territory when it is not within or above the land area or territorial waters of the United States.
Payment may not be made for any purchased items provided or delivered to the beneficiary outside the United States, even though the beneficiary may have contracted to purchase the item while he was within the United States or purchased the item from an American firm. See HI 00610.240 for rules on rental and periodic purchase payments for durable medical equipment used outside the United States.