Medicare Managed Care Manual (Pub. 100-16), Ch. 18c § 50
Emergency and Urgently Needed Medical Services and Other
50 - Emergency and Urgently Needed Medical Services and Other
Covered Medical Services for which the HCPP Assumes Financial
Responsibility
(Rev. 30, 09-05-03)
Payments for services to nonplan physicians and suppliers for purchased services, such as
emergency or urgently needed care outside the HCPP or unusual specialty services not
available within the HCPP, are apportioned to Medicare enrollees in accordance with the
principles set forth in §40 of this chapter. In most cases, this will limit CMS' payment to
the HCPP to what the FFS system would have paid for the service in that area.