Page 2 - Medicare Benefit Policy Manual
P. 2
50.4 - TRICARE and CHAMPVA (Civilian Health and Medical Program of
Veterans Administration)
50.5 - Active Duty Members of Uniformed Services
60 - Services Not Provided Within United States
70 - Services Resulting from War
80 - Personal Comfort Items
90 - Routine Services and Appliances
100 - Hearing Aids and Auditory Implants
110 - Custodial Care
110.1 - Custodial Care Under a Hospice Program
120 - Cosmetic Surgery
130 - Charges Imposed by Immediate Relatives of the Patient or Members of the
Patient’s Household
140 - Dental Services Exclusion
150 - Services Reimbursable Under Automobile, No Fault, Any Liability Insurance or
Workers’ Compensation
170 - Inpatient Hospital or SNF Services Not Delivered Directly or Under Arrangement
by the Provider
180 - Services Related to and Required as a Result of Services Which Are Not Covered
Under Medicare
