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Medicare Part B

Medicare Part B

Overview

Medicare Part B, the Supplementary Medical Insurance (SMI) program, is a voluntary insurance program for the aged and disabled. The Part B program is supplemental to the Part A program and generally covers:

  • Physician services
  • Nonphysician services (e.g., Certified Registered Nurse Anesthetists, physician’s assistant, clinical social workers, nurse midwives, etc.)
  • Supplies “incident to” physicians’ services, e.g., drugs (not self-administered with certain exceptions)
  • Nonphysician services “incident to” physicians’ services
  • Outpatient services (including outpatient surgical services)
  • Diagnostic services furnished to outpatients by or under arrangements made by a hospital or a critical access hospital
  • Diagnostic laboratory, X-ray and other diagnostic tests
  • Medical supplies, appliances, and devices
  • Durable medical equipment prosthetics, orthotics and supplies (DMEPOS)
  • Ambulance services
  • Outpatient physical therapy and speech pathology services
  • Pneumococcal vaccinations, hepatitis B vaccine, blood clotting factors for hemophilia patients 42 C.F.R. § 410.10

Part B covers “medical and other health care services” subject to specific coverage exclusions and conditions of coverage as well as exclusions resulting from the noninclusion of services in the statutory definition of the term “medical and other health care services.” 42 C.F.R. § 424.24.

Excerpt from Barry D. Alexander, Medicare Part B, Fundamentals of Health Law (American Health Lawyers Association Nov. 2011).

Agency Guidance

Federal funding for Part B services is derived solely from the Supplementary Medical Insurance (SMI) Trust Fund which is generated from general tax revenues and earned interest income. Beneficiaries contribute out-of-pocket for the care they receive under Part B in the form of monthly premium payments, deductibles and co-insurance.

Excerpt from Barry D. Alexander and James F. Flynn, Medicare Fundamentals : Intro, Fundamentals of Health Law (American Health Lawyers Association Nov. 2011).