Page 24 - Medicare Benefit Policy Manual

and available to provide treatment of the illness or injury (see Pub. 100-04,
Medicare Claims Processing Manual Chapter 3, Inpatient Hospital Billing,
Section 110 for a description of claims processing procedures);

• 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 (see Pub. 100-04, Medicare Claims Processing Manual Chapter 1,
General Billing Requirements, Section 10.1.4.1 for a description of claims
processing procedures);

• 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 (see Pub. 100-04,
Medicare Claims Processing Manual Chapter 1, General Billing Requirements,
Section 10.1.4.7 for a description of claims processing procedures); and

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

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 they were within the United States or purchased the item from an American firm.

Payment may not be made for a medical service (or a portion of it) that was
subcontracted to another provider or supplier located outside the United States. For
example, if a radiologist who practices in India analyzes imaging tests that were
performed on a beneficiary in the United States, Medicare would not pay the radiologist
or the U.S. facility that performed the imaging test for any of the services that were
performed by the radiologist in India.

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: