# 42 CFR § 411.4: Items and services for which neither the beneficiary nor any other person is legally obligated to pay > Federal · Regulations · In force URL: https://www.frixlaw.com/law-library/statutes/ecfr-42-411.4 ## Section - **Citation:** 42 CFR § 411.4 - **Heading:** Items and services for which neither the beneficiary nor any other person is legally obligated to pay - **Jurisdiction:** Federal - **Kind:** Regulations - **Status:** In force - **Text as of:** September 22, 2026 - **Source:** Publisher's official text - **Location:** Title 42—Public Health > CHAPTER IV—CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES > SUBCHAPTER B—MEDICARE PROGRAM > PART 411—EXCLUSIONS FROM MEDICARE AND LIMITATIONS ON MEDICARE PAYMENT > Subpart A—General Exclusions and Exclusion of Particular Services ## Text (a) General rule. Except in the case of federally qualified health center services and as provided in § 411.8(b) (for services paid by a governmental entity), Medicare may not pay for an item or service under Part A or Part B if— (1) The individual has no legal obligation to pay for the item or service; and (2) No other person (by reason of such individual's membership in a prepayment plan or otherwise) has a legal obligation to provide or pay for the item or service. (b) Special conditions for payment for items or services furnished to an individual in the custody of a penal authority. (1) An individual in the custody of a penal authority is considered to have a legal obligation to pay for items or services furnished to the individual only if the following conditions are met: (i) State or local law requires the individual to pay the cost of items and services that the individual receives; (ii) The penal authority enforces the requirement to pay for items or services by billing all individuals who receive such items or services, whether or not covered by Medicare or any other health insurance; and (iii) The penal authority pursues collection of amounts owed for items or services received in the same way and with the same vigor that it pursues the collection of other debts. (2) For purposes of this paragraph (b), a penal authority means a police department or other law enforcement agency, a government agency operating under a penal statute, or a State, local or Federal jail, prison, penitentiary, or similar institution. (3) For purposes of this paragraph (b)— (i) An individual is considered to be in the custody of a penal authority if the individual is: (A) Incarcerated in a jail, prison, penitentiary, or similar institution; (B) Temporarily outside of a jail, prison, penitentiary, or similar institution on medical furlough or similar arrangement; (C) Escaped from confinement by a penal authority; or (D) Required to reside in a mental health facility under a penal statute or rule. (ii) Individuals who are not considered to be in the custody of a penal authority include, but are not limited to, individuals who are— (A) Released to the community pending trial (including those in pretrial community supervision and those released pursuant to cash bail); (B) On parole; (C) On probation; (D) On home detention or home confinement; or (E) Required to live in a halfway house or other community-based transitional facility. [89 FR 94587, Nov. 27, 2024] ## Nearby sections - [42 CFR § 411.1 § 411.1 Basis and scope.](https://www.frixlaw.com/law-library/statutes/ecfr-42-411.1.md) - [42 CFR § 411.2 § 411.2 Conclusive effect of QIO determinations on payment of claims.](https://www.frixlaw.com/law-library/statutes/ecfr-42-411.2.md) - [42 CFR § 411.4 § 411.4 Items and services for which neither the beneficiary nor any other person is legally obligated to pay.](https://www.frixlaw.com/law-library/statutes/ecfr-42-411.4.md) - [42 CFR § 411.6 § 411.6 Services furnished by a Federal provider of services or other Federal agency.](https://www.frixlaw.com/law-library/statutes/ecfr-42-411.6.md) - [42 CFR § 411.7 § 411.7 Services that must be furnished at public expense under a Federal law or Federal Government contract.](https://www.frixlaw.com/law-library/statutes/ecfr-42-411.7.md) - [42 CFR § 411.8 § 411.8 Services paid for by a Government entity.](https://www.frixlaw.com/law-library/statutes/ecfr-42-411.8.md) - [42 CFR § 411.9 § 411.9 Services furnished outside the United States.](https://www.frixlaw.com/law-library/statutes/ecfr-42-411.9.md) - [42 CFR § 411.10 § 411.10 Services required as a result of war.](https://www.frixlaw.com/law-library/statutes/ecfr-42-411.10.md) - [42 CFR § 411.12 § 411.12 Charges imposed by an immediate relative or member of the beneficiary's household.](https://www.frixlaw.com/law-library/statutes/ecfr-42-411.12.md) - [42 CFR § 411.15 § 411.15 Particular services excluded from coverage.](https://www.frixlaw.com/law-library/statutes/ecfr-42-411.15.md) - [42 CFR § 411.20 § 411.20 Basis and scope.](https://www.frixlaw.com/law-library/statutes/ecfr-42-411.20.md) - [42 CFR § 411.21 § 411.21 Definitions.](https://www.frixlaw.com/law-library/statutes/ecfr-42-411.21.md) - [42 CFR § 411.22 § 411.22 Reimbursement obligations of primary payers and entities that received payment from primary payers.](https://www.frixlaw.com/law-library/statutes/ecfr-42-411.22.md) - [42 CFR § 411.23 § 411.23 Beneficiary's cooperation.](https://www.frixlaw.com/law-library/statutes/ecfr-42-411.23.md) --- Source: Frix Law Library, https://www.frixlaw.com/law-library/statutes/ecfr-42-411.4. Check the current official text before relying on it. Not legal advice.