# 42 CFR § 411.9: Services furnished outside the United States

> Federal · Regulations · In force

URL: https://www.frixlaw.com/law-library/statutes/ecfr-42-411.9

## Section

- **Citation:** 42 CFR § 411.9
- **Heading:** Services furnished outside the United States
- **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) Basic rule. Except as specified in paragraph (b) of this section, Medicare does not pay for services furnished outside the United States. For purposes of this paragraph (a), the following rules apply:
(1) The United States includes the 50 States, the District of Columbia, Puerto Rico, the Virgin Islands, Guam, American Samoa, The Northern Mariana Islands, and for purposes of services rendered on board ship, the territorial waters adjoining the land areas of the United States.
(2) Services furnished on board ship are considered to have been furnished in United States territorial waters if they were furnished while the ship was in a port of one of the jurisdictions listed in paragraph (a)(1) of this section, or within 6 hours before arrival at, or 6 hours after departure from, such a port.
(3) A hospital that is not physically situated in one of the jurisdictions listed in paragraph (a)(1) of this section is considered to be outside the United States, even if it is owned or operated by the United States Government.
(b) Exception. Under the circumstances specified in subpart H of part 424 of this chapter, payment may be made for covered inpatient services furnished in a foreign hospital and, on the basis of an itemized bill, for covered physicians' services and ambulance service furnished in connection with those inpatient services, but only for the period during which the inpatient hospital services are furnished.

## 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)

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Source: Frix Law Library, https://www.frixlaw.com/law-library/statutes/ecfr-42-411.9. Check the current official text before relying on it. Not legal advice.