General

30.1 – General (Rev. 12438; Issued: 01-04-24; Effective: 02-06-24; Implementation: 02-06-24) The provision of 42 CFR § 411.40(b) provides that no Medicare payment may be made for items and services to the extent that payment has been made or can reasonably be expected to be made for such items or services under a workers' compensation (WC) law or plan of the United States or any state. Further, no Medicare payment may be made if a WC plan has paid an amount: a) Which equals or exceeds the Medicare reasonable charge; b) Which equals or exceeds the provider’s charges for Medicare covered services; or c) Which the provider, physician, or other supplier accepts or is required under the WC law to accept as payment in full.