SSA's Policy Information Site - POMS

Program Operations Manual System (POMS)

Subchapter List for Covered Services (HI-SMI)

HI 006: Covered Services (HI-SMI)

HI 00600: Covered Services (HI-SMI)

HI 00600.000: Covered Services (HI-SMI) - Table of Contents

HI 00601: Hospital Insurance

HI 00601.000: Hospital Insurance - Table of Contents

HI 00601.001: Scope of Benefits

HI 00601.005: Covered Part A Inpatient Hospital Services

HI 00601.010: Hospital Inpatient Services - Coverage Guidelines

HI 00601.015: Bed and Board

HI 00601.020: Nursing and Other Services

HI 00601.025: Drugs and Biologicals

HI 00601.030: Supplies, Appliances and Equipment

HI 00601.035: Other Diagnostic or Therapeutic Items or Services

HI 00601.040: Services of Interns or Residents-in-Training

HI 00601.045: Inpatient Services in Connection with Dental Services

HI 00601.050: Therapy Services

HI 00601.055: Inpatient Hospital Services Counting Toward Maximums

HI 00601.060: Guarantee of Payment for Inpatient Hospital Service

HI 00601.065: Lifetime Reserve Days

HI 00601.070: Inpatient Day Defined

HI 00601.075: Late Discharge

HI 00601.080: Leaves of Absence

HI 00601.085: Discharge or Death on First Day of Entitlement or Participation

HI 00601.090: Limitation on Inpatient Psychiatric Benefits in Initial Benefit Period

HI 00601.095: Patient's Status in Applying Reduction

HI 00601.100: Institution's Status in Determining Reduction in Days

HI 00601.105: Counting Days of Admission, Discharge, and Leave in Reducing Days

HI 00601.110: Inpatient Psychiatric Hospital Services—Lifetime Limitation

HI 00601.115: Inpatient Service Days Counting Toward Maximums

HI 00601.120: Coverage of Extended Care Services

HI 00601.125: SNF Coverage Guidelines

HI 00601.130: Prior Hospitalization and Transfer Requirements

HI 00601.135: Covered Level of Care

HI 00601.140: Daily Skilled Service

HI 00601.145: Skilled Nursing Services

HI 00601.150: Nonskilled Nursing Services

HI 00601.155: Questionable Situations

HI 00601.160: Physical Therapy as Basis for Extended Care

HI 00601.165: Other Rehabilitation Service as a Basis for Extended Care

HI 00601.170: Need Satisfied Only by SNF Inpatient Care

HI 00601.175: Covered Extended Care Services

HI 00601.180: Nursing Care Provided by or Under the Supervision of a Registered Professional Nurse

HI 00601.185: Bed and Board in Semi-Private Accommodations Furnished in Connection With Nursing Care

HI 00601.190: Physical, Speech and Occupational Therapy Furnished by the SNF or by Others Under Arrangements with the SNF and Under Its Supervision

HI 00601.195: Medical Social Services

HI 00601.200: Drugs and Biologicals

HI 00601.205: Supplies, Appliances and Equipment

HI 00601.210: Medical Services of an Intern or Resident-in-Training

HI 00601.220: Other Diagnostic or Therapeutic Services Provided by a Hospital

HI 00601.230: Other Services

HI 00601.270: Extended Care Benefit Days

HI 00601.280: Inpatient Extended Care Services Counting Toward Maximums

HI 00601.290: Covered Hospice Services

HI 00601.295: Hospice Care - Requirements for Coverage

HI 00601.300: Home Health Services

HI 00601.310: HHA Coverage—Discussion Guidelines

HI 00601.320: Nursing Care

HI 00601.330: Definition of Intermittent

HI 00601.340: When Skilled Nursing Care is Reimbursable

HI 00601.350: Skilled Nursing Services—Examples

HI 00601.360: Student Nurses

HI 00601.370: Psychiatric Nursing

HI 00601.380: Physical, Speech and Occupational Therapy Furnished by an HHA or by Others Under Arrangements With the HHA and Under its Supervision

HI 00601.390: Medical Social Services

HI 00601.400: Services of a Home Health Aide

HI 00601.410: Medical Supplies (Except for Drugs and Biologicals) and the Use of Medical Appliances

HI 00601.420: Services of Interns and Residents

HI 00601.430: Outpatient Services

HI 00601.440: Part Time or Intermittent Services

HI 00601.450: Counting Visits Under the Hospital and Medical Plans

HI 00601.460: Specific Exclusions from Coverage as Home Health Services

HI 00601.470: Special Conditions for Coverage of Home Health Services Under Hospital Insurance (Part A)

HI 00601.480: Fourteen Day Limit on Plan Establishment

HI 00601.490: Related Illness or Impairment

HI 00601.500: Transfer of Patient

HI 00601.510: Duration of Home Health Services Under Hospital Insurance

HI 00601.520: Presumption of Coverage

HI 00601.550: Inpatient Hospital Deductible

HI 00601.560: Inpatient Hospital Coinsurance

HI 00601.570: Extended Care Coinsurance

HI 00601.575: Basis for Determining the Coinsurance Amounts

HI 00601.580: Part A Blood Deductible

HI 00601.590: Background

HI 00601.600: Provider Charges to Beneficiaries for Excess Costs

HI 00601.610: Determining Emergency Services

HI 00601.620: District Office Role

HI 00610: Supplementary Medical Insurance

HI 00610.000: Supplementary Medical Insurance - Table of Contents

HI 00610.001: Scope of Benefits(SMI)

HI 00610.010: Incurred Expenses

HI 00610.020: When SMI Expenses Are Incurred

HI 00610.030: Physicians' Services

HI 00610.040: Provider-Based Physicians' Services

HI 00610.050: Services of Interns and Residents

HI 00610.060: Supervising Physicians in the Teaching Setting

HI 00610.070: Radiological and Pathological Services to Hospital Inpatients

HI 00610.080: Coverage of Chiropractic Services

HI 00610.090: Services of Physical Therapists in Independent Practice

HI 00610.100: Services and Supplies

HI 00610.110: Drugs and Biologicals

HI 00610.120: Diagnostic X-Ray, Diagnostic Laboratory, and Other Diagnostic Tests

HI 00610.130: Diagnostic Laboratory Services Furnished by an Independent Laboratory

HI 00610.140: Psychologists Practicing Independently

HI 00610.150: Otologic Evaluations

HI 00610.160: Portable X-Ray Services

HI 00610.170: X-Ray, Radium and Radioactive Isotope Therapy

HI 00610.180: Surgical Dressings, and Splints, Casts, and Other Devices Used for Reduction of Fractures and Dislocations

HI 00610.190: Rental and Purchase of Durable Medical Equipment (DME)

HI 00610.200: Definition of Durable Medical Equipment

HI 00610.210: Necessary and reasonable

HI 00610.220: Repairs, Maintenance, Replacement and Delivery

HI 00610.230: Coverage of Supplies and Accessories

HI 00610.240: Miscellaneous Issues Included in the Coverage of Equipment

HI 00610.250: Ambulance Service

HI 00610.260: Air Ambulance Service

HI 00610.270: Prosthetic Devices

HI 00610.280: Leg, Arm, Back, and Neck Braces, Trusses, and Artificial Legs, Arms and Eyes

HI 00610.290: Dental Services

HI 00610.300: Examples of Durable Medical Equipment Covered and Not Covered

HI 00610.302: Ambulatory Surgery

HI 00610.304: Antigens

HI 00610.306: Pneumococcal Vaccine and Its Administration

HI 00610.310: Treatment of End-Stage Renal Disease

HI 00610.320: Dialysis Settings

HI 00610.330: Physician's Services for ESRD

HI 00610.340: Home Dialysis Aides

HI 00610.345: Organ Transplants

HI 00610.350: Payment for Medical and Other Health Services Furnished by Hospitals and SNF's

HI 00610.360: Outpatient Hospital Services

HI 00610.370: Outpatient Physical Therapy and Speech Pathology

HI 00610.375: Comprehensive Outpatient Rehabilitation Facility (CORF) Services

HI 00610.380: Outpatient Occupational Therapy Services

HI 00610.390: Home Health Benefits

HI 00610.400: Duration of Home Health Services Under SMI

HI 00610.410: Home Health Agencies Furnishing Medical and Other Health Services

HI 00610.420: Special Option While Under a Home Health Plan

HI 00610.430: Annual Part B Cash Deductible

HI 00610.431: Special Carryover Rule for Expenses Incurred Prior to 1981

HI 00610.440: Coinsurance

HI 00610.450: Exceptions to Part B Deductible and Coinsurance

HI 00610.460: Group Practice Prepayment Plan

HI 00610.470: Medical Insurance Blood Deductible

HI 00610.480: Noninpatient Psychiatric Services Limitation — Expenses Incurred for Physician's Services

HI 00610.490: Noninpatient Psychiatric Services Limitation Computation

HI 00610.510: Determining When the Limitation Applies

HI 00620: Exclusions from Coverage

HI 00620.000: Exclusions from Coverage - Table of Contents

HI 00620.001: General Exclusions

HI 00620.010: Services Not Reasonable and Necessary

HI 00620.020: No Obligation to Pay for or Provide Services

HI 00620.030: Items and Services Furnished or Paid for by Governmental Entities

HI 00620.040: Items and Services Furnished by a Federal Provider of Services or Federal Agency

HI 00620.050: Items and Services which a Provider, Physician or Supplier is Obligated to Furnish at Public Expense Pursuant to an Authorization Issued by a Federal Agency

HI 00620.060: Items or Services Which are Paid For by a Governmental Entity

HI 00620.070: Illustrations

HI 00620.080: Services Not Provided Within the United States

HI 00620.090: Services Resulting From War

HI 00620.100: Personal Comfort Items

HI 00620.110: Routine Services and Appliances

HI 00620.120: Supportive Devices for Feet

HI 00620.130: Custodial Care

HI 00620.140: Cosmetic Surgery

HI 00620.150: Charges Imposed by Immediate Relatives of the Patient or Members of His Household

HI 00620.160: Dental Services Exclusion

HI 00620.170: Workers' Compensation

HI 00620.171: Private Right of Action

HI 00620.175: Services Reimbursable Under Automobile, No-Fault, or Any Liability Insurance

HI 00620.177: Medicare as Secondary Payer for End Stage Renal Disease (ESRD) Beneficiaries and for Employed Beneficiaries Age 65 or Over (Working Aged) and the Spouses Age 65 or Over of Employed Individuals of Any Age

HI 00620.178: Medicare as Secondary Payer for Disabled Individuals

HI 00620.180: Excluded Foot Care Services

HI 00620.190: Application of Foot Care Exclusion to Physicians' Services

HI 00620.200: Exclusion of Refractive Services

HI 00630: Medicare Coverage Outside U.S.

HI 00630.000: Medicare Coverage Outside U.S. - Table of Contents

HI 00630.001: Medicare Program Outside the United States - General

HI 00630.010: Enrollment Procedures - General

HI 00630.020: Initial Enrollment Procedures - Foreign Beneficiaries on the Social Security Rolls Approaching Age 65 or Disabled for 24 Months

HI 00630.030: Developing Foreign Retirement, Survivors, and Disability Insurance (RSDI) Claims When Claimant May Be Eligible for Supplementary Medical Insurance (SMI)

HI 00630.040: Processing Claims Involving Possible Coverage Under The Health Insurance Programs for Individuals at Least Age 65 Who Are Not Entitled to Monthly Benefits

HI 00630.060: SMI Terminations and Withdrawals - General

HI 00630.070: Processing by the Modules - Medicare Outside U.S.

HI 00630.080: Procedure for the Issuance of an HI or SMI Card

HI 00630.090: Supplementary Medical Insurance Premium Collection in DIO - General

HI 00630.100: Mailroom Procedures - Medicare Outside U.S.

HI 00630.110: Deposit Clerk's Procedure - Medicare Outside U.S.

HI 00630.120: Direct Action Unit Processing of SSA-1592 Remittances

HI 00630.130: General Enrollment Period - Medicare Outside U.S.

HI 00630.140: Handling Inquiries Relating to Medicare - General

HI 00630.150: Inquiries Requesting Payment for Noncovered Hospital or Medical Services Furnished Outside the United States

HI 00630.160: Inquiries Requesting Payment or Claims Assistance Relating to Medicare Services Furnished in the United States

HI 00630.170: Other Medicare Inquiries

HI 00630.180: List of Exhibits - Medicare Outside U.S.