Definition of Emergency Inpatient and Outpatient Services

20.1 - Definition of Emergency Inpatient and Outpatient Services (Rev. 1, 09-11-02) Payment may be made for certain Part A inpatient hospital services and Part B outpatient hospital services provided in a nonparticipating U.S. hospital where they are necessary to prevent the death or serious impairment of the health of the individual. Because of the threat to the life or health of the individual, the use of the most accessible hospital equipped to furnish such services is necessary. The determination of emergency services depends upon three separate findings: • The hospital meets the definition of an emergency hospital (see §20.2 of this chapter), • The services meet the definition of emergency services (see Claims Processing Manual, Chapter 3, §110), and • The hospital is substantially more accessible from the site of the emergency than is the nearest participating hospital.