US · guidance
CMS Pub. 100-04, ch. 30, § 150.5.2.5
Presumption When Advance Determination was Requested
In determining whether the supplier knew, or could reasonably have been expected to
know, before furnishing the item, that Medicare would deny payment in advance under
§1834(a)(15) of the Act, presume that the supplier knew that Medicare would not pay in
all those cases in which a request for advance determination was made, and the contractor
denied payment in advance on the basis that the item is not reasonable and necessary
under §1862(a)(1) of the Act or that the item is not covered. This is a nonrebuttable
presumption.
History
(Rev. 1587, Issued: 09-05-08, Effective: 03-03-08, Implementation: 03-01-09)
Provenance
- Source
- cms.gov
- Retrieved
- 2026-08-25
- Edition
- iom-2026-08-25
- Content hash
fb76e01b798afbf440af83386ab62a6ea1307f2130d92db5884e5f97a53c8d7f
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