CMS Pub. 100-04, ch. 32, § 350.1

A. Services in Nonparticipating Domestic Hospital

Payment may be made for certain Part A inpatient and Part B outpatient hospital services provided in a nonparticipating

U.S. hospital where they are necessary to prevent the death or serious impairment of the health of the individual.

Because of the threat to the life or health of the individual, the use of the most accessible hospital equipped to furnish

such services is necessary. Items and services furnished in a domestic nonparticipating hospital may be reimbursed if

the following apply:

The hospital meets the definition of an emergency hospital. (See §350.3.)

The services meet the definition of emergency services. (See §350.2.)

The hospital is substantially more accessible from the site of the emergency than is the nearest participating

hospital. (See §350.4.)

B. Services Received by Medicare Beneficiaries outside the United States

Items and services furnished outside the United States and certain services rendered on board a ship are excluded from

coverage except for the following services:

Emergency inpatient hospital services where the emergency occurred:

o While the beneficiary was physically present in the United States; or

o In Canada while the beneficiary was traveling without reasonable delay and by the most direct route between

Alaska and another State.

Emergency or nonemergency inpatient hospital services furnished by a hospital located outside the United States,

if the hospital was closer to, or substantially more accessible from, the beneficiary’s United States residence than

the nearest participating United States hospital that was adequately equipped to deal with, and available to

provide treatment for the illness or injury.

Physician and ambulance services furnished in connection with a covered foreign hospitalization. Program

payment may not be made for any other Part B medical and other health services, including outpatient services

furnished outside the United States.

Services rendered on board a ship in a United States port, or within 6 hours of when the ship arrived at, or

departed from, a United States port, are considered to have been furnished in United States territorial waters.

Services not furnished in a United States port, or within 6 hours of when the ship arrived at, or departed from, a

United States port, are considered to have been furnished outside United States territorial waters, even if the ship

is of United States registry.

The term “United States” means the 50 States, the District of Columbia, the Commonwealth of Puerto Rico, the U.S.

Virgin Islands, Guam, the Northern Mariana Islands, American Samoa and, for purposes of services rendered on a ship,

includes the territorial waters adjoining the land areas of the United States.

A hospital that is not physically situated in one of the above jurisdictions is considered to be outside the United States,

even if it is owned or operated by the United States Government.

C. Ship Physician’s Office is in the United States.

When the physician’s office is inside of the United States, the contractor designated to process the shipboard claim is

determined by the beneficiary’s residence.

D. Ship Physician’s Office is Outside of the United States.

When the physician’s office is outside of the United States, the contractor designated to process the shipboard claim is

determined by the beneficiary’s residence.

MSN message 16.240 (English)

Services provided aboard a ship are covered only when the ship is in United States waters. In addition, the service must

be provided by a doctor licensed to practice in the United States.

MSN message 16.240 (Spanish)

Servicios proporcionados abordo de un barco son cubiertos solamente cuando el barco está en aguas territoriales de los

Estados Unidos. Además, el servicio debe ser proporcionado por un médico con licencia para practicar en los Estados

Unidos.

Payment may not be made for any item provided or delivered to the beneficiary outside the United States, even though

the beneficiary may have contracted to purchase the item while he or she was within the United States or purchased the

item from an American firm.

Under the Railroad Retirement Act, payment is made to qualified Railroad Retirement beneficiaries (QRRBs) by the

RRB for covered hospital services furnished in Canadian hospitals as well as in the U.S. Physician and ambulance

services are not covered by the Railroad Retirement Act; however, under an agreement between CMS and RRB, if the

QRRB claims payment for Part B services in connection with Canadian hospitalization, RRB processes the Part B claim.

In such cases the RRB determines:

Whether the requirements are met for the inpatient services; and

Whether the physician and/or ambulance services were furnished in connection with the services.

Services for an individual who has elected religious nonmedical health care status may be covered if the above

requirements are met but this revokes the religious nonmedical health care institution election.