CFR > Title 5 - Administrative Personnel > CHAPTER I—OFFICE OF PERSONNEL MANAGEMENT > SUBCHAPTER B—CIVIL SERVICE REGULATIONS (parts 110 to 990) > PART 890—FEDERAL EMPLOYEES HEALTH BENEFITS PROGRAM > SUBPART I—Limit on Inpatient Hospital Charges, Physician Charges, and FEHB Benefit Payments (§890.901 to §890.910) > 890.903—Covered services.

890.903—Covered services.

(a) The limitation on the charges and FEHB benefit payments for inpatient hospital services apply to inpatient hospital services which are:
(1) Covered under both Medicare part A and the retired enrolled individual's FEHB plan; and
(2) Supplied to a retired enrolled individual who does not have Medicare part A; and
(3) Provided by hospital providers who have in force participation agreements with the Secretary of Health and Human Services (HHS) consistent with sections 1814(a) and 1866 of the Social Security Act, and receive Medicare part A payments in accordance with the diagnosis related group (DRG) based prospective payment system (PPS).
(b) The limitation on the charges and FEHB benefit payments for physician services apply to physician services, (as defined in section 1848(j) of the Social Security Act), which are:
(1) Covered under both Medicare part B and the retired enrolled individual's FEHB plan; and
(2) Supplied to a retired enrolled individual who does not have Medicare part B.

Code of Federal Regulations

[60 FR 26668, May 18, 1995]