# 42 C.F.R. § 410.12 (2026): Medical and other health services: Basic conditions and limitations

> Federal · Regulations · In force

URL: https://www.frixlaw.com/law-library/statutes/CFR_T42_P410_S410_12

## Section

- **Citation:** 42 C.F.R. § 410.12 (2026)
- **Heading:** Medical and other health services: Basic conditions and limitations
- **Jurisdiction:** Federal
- **Kind:** Regulations
- **Status:** In force
- **Text as of:** August 14, 2026
- **Source:** Compiled text
- **Location:** Title 42 CFR: Public Health / Chapter IV: CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES / Part 410: SUPPLEMENTARY MEDICAL INSURANCE (SMI) BENEFITS / Subpart B: Medical and Other Health Services / § 410.12: § 410.12   Medical and other health services: Basic conditions and limitations.

## Text

(a)
Basic conditions.
The medical and other health services specified in § 410.10 are covered by Medicare Part B only if they are not excluded under subpart A of part 411 of this chapter, and if they meet the following conditions:
(1)
When the services must be furnished.
The services must be furnished while the individual is in a period of entitlement. (The rules on entitlement are set forth in part 406 of this chapter.)
(2)
By whom the services must be furnished.
The services must be furnished by a facility or other entity as specified in §§ 410.14 through 410.69.
(3)
Physician certification and recertification requirements.
If the services are subject to physician certification requirements, they must be certified as being medically necessary, and as meeting other applicable requirements, in accordance with subpart B of part 424 of this chapter.
(b)
Limitations on payment.
Payment for medical and other health services is subject to limitations on the amounts of payment as specified in §§ 410.152 and 410.155 and to the annual and blood deductibles as set forth in §§ 410.160 and 410.161.
[51 FR 41339, Nov. 14, 1986, as amended at 53 FR 6648, Mar. 2, 1988; 57 FR 33896, July 31, 1992]

## Nearby sections

- [42 C.F.R. § 410.10 (2026) § 410.10   Medical and other health services: Included services.](https://www.frixlaw.com/law-library/statutes/CFR_T42_P410_S410_10.md)
- [42 C.F.R. § 410.12 (2026) § 410.12   Medical and other health services: Basic conditions and limitations.](https://www.frixlaw.com/law-library/statutes/CFR_T42_P410_S410_12.md)
- [42 C.F.R. § 410.14 (2026) § 410.14   Special requirements for services furnished outside the United States.](https://www.frixlaw.com/law-library/statutes/CFR_T42_P410_S410_14.md)
- [42 C.F.R. § 410.15 (2026) § 410.15   Annual wellness visits providing Personalized Prevention Plan Services: Conditions for and limitations on coverage.](https://www.frixlaw.com/law-library/statutes/CFR_T42_P410_S410_15.md)
- [42 C.F.R. § 410.16 (2026) § 410.16   Initial preventive physical examination: Conditions for and limitations on coverage.](https://www.frixlaw.com/law-library/statutes/CFR_T42_P410_S410_16.md)
- [42 C.F.R. § 410.17 (2026) § 410.17   Cardiovascular disease screening tests.](https://www.frixlaw.com/law-library/statutes/CFR_T42_P410_S410_17.md)
- [42 C.F.R. § 410.18 (2026) § 410.18   Diabetes screening tests.](https://www.frixlaw.com/law-library/statutes/CFR_T42_P410_S410_18.md)
- [42 C.F.R. § 410.19 (2026) § 410.19   Ultrasound screening for abdominal aortic aneurysms: Condition for and limitation on coverage.](https://www.frixlaw.com/law-library/statutes/CFR_T42_P410_S410_19.md)
- [42 C.F.R. § 410.20 (2026) § 410.20   Physicians' services.](https://www.frixlaw.com/law-library/statutes/CFR_T42_P410_S410_20.md)
- [42 C.F.R. § 410.21 (2026) § 410.21   Limitations on services of a chiropractor.](https://www.frixlaw.com/law-library/statutes/CFR_T42_P410_S410_21.md)
- [42 C.F.R. § 410.22 (2026) § 410.22   Limitations on services of an optometrist.](https://www.frixlaw.com/law-library/statutes/CFR_T42_P410_S410_22.md)
- [42 C.F.R. § 410.23 (2026) § 410.23   Screening for glaucoma: Conditions for and limitations on coverage.](https://www.frixlaw.com/law-library/statutes/CFR_T42_P410_S410_23.md)
- [42 C.F.R. § 410.24 (2026) § 410.24   Limitations on services of a doctor of dental surgery or dental medicine.](https://www.frixlaw.com/law-library/statutes/CFR_T42_P410_S410_24.md)
- [42 C.F.R. § 410.25 (2026) § 410.25   Limitations on services of a podiatrist.](https://www.frixlaw.com/law-library/statutes/CFR_T42_P410_S410_25.md)

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Source: Frix Law Library, https://www.frixlaw.com/law-library/statutes/CFR_T42_P410_S410_12. Check the current official text before relying on it. Not legal advice.