US · guidance
CMS Pub. 100-10, ch. 9, § 9055.1
Payment to an Excluded Practitioner or Other Person –
Regulatory Requirements
(Rev. 24, Issued: 02-12-16, Effective: 03-14-16, Implementation: 03-14-16)
1. Payment will not be made under the Medicare, Medicaid, or any other Federal
health care programs as defined in §1128B(f) of the Act, including State health
care programs as defined in §1128(h), to an excluded practitioner or other person
for items or services furnished, ordered, or prescribed during the period of
exclusion.
2. Payment will not be made under Medicare, Medicaid, or any other Federal health
care programs to any provider for items or services ordered by an excluded
practitioner or other person when the order was a necessary precondition for
payment under Medicare when the person furnishing the item or service knew or
had reason to know of the exclusion.
3. Assignment of a beneficiary’s claim for items or services furnished or ordered by
an excluded practitioner or other person on or after the effective date of exclusion
will not be valid.
History
(Rev. 24, Issued: 02-12-16, Effective: 03-14-16, Implementation: 03-14-16)
Provenance
- Source
- cms.gov
- Retrieved
- 2026-08-25
- Edition
- iom-2026-08-25
- Content hash
831d67bdfe7c32ff0a21abd7939d3e6708da1fa004d7141cb67c391ae4ad33b7
The link goes to the issuing authority’s own document — the one we read to produce this record. Where a source publishes whole titles rather than sections, your browser may need a moment to jump to the provision.
Unofficial copy of government-published law, reproduced from official sources with full provenance. Not an official publication; verify against official sources before relying on it in a filing. Records in the 'guidance' corpus, and only that corpus, are sub-regulatory (interpretive guidelines, survey procedures) and are not binding law. Validity bounds follow each jurisdiction's declared temporalBasis.