42 CFR 489.23
§ 489.23 Specific limitation on charges for services provided to certain enrollees of fee-for-service FEHB plans.
United States · 42 CFR — Public Health · Status: effective
Cite this
- Citation
- 42 CFR 489.23, § 489.23 Specific limitation on charges for services provided to certain enrollees of fee-for-service FEHB plans, United States, version 1 as recorded 2026-07-09, yourstate.us, https://yourstate.us/provision/207648
- Permanent ID
ys:prov:207648@1- SHA-256
bbb9efccb023af581b29dd844af50564b85e94d6f9680a85b3e2cc63454ab433
The hash is SHA-256 of this version's text, with every run of whitespace collapsed to a single space and the ends trimmed. The ID always leads back here, and checking it says whether the text you cited is still the current version.
Full text
A provider that furnishes inpatient hospital services to a retired Federal worker age 65 or older who is enrolled in a fee-for-service FEHB plan and who is not covered under Medicare Part A, must accept, as payment in full, an amount that approximates as closely as possible the Medicare inpatient hospital prospective payment system (PPS) rate established under part 412. The payment to the provider is composed of a payment from the FEHB plan and a payment from the enrollee. This combined payment approximates the Medicare PPS rate. The payment from the FEHB plan approximates, as closely as possible, the Medicare PPS rate minus any applicable enrollee deductible, coinsurance, or copayment amount. The payment from the enrollee is equal to the applicable deductible, coinsurance, or copayment amount.
Legislative history
This is a federal regulation, adopted through agency rulemaking under the Administrative Procedure Act — not enacted by a recorded vote of Congress.