[Code of Federal Regulations]
[Title 5, Volume 2]
[Revised as of January 1, 2005]
From the U.S. Government Printing Office via GPO Access
[CITE: 5CFR890.903]

[Page 483]
 
                    TITLE 5--ADMINISTRATIVE PERSONNEL
 
          CHAPTER I--OFFICE OF PERSONNEL MANAGEMENT (CONTINUED)
 
PART 890_FEDERAL EMPLOYEES HEALTH BENEFITS PROGRAM--Table of Contents
 
 Subpart I_Limit on Inpatient Hospital Charges, Physician Charges, and 
                          FEHB Benefit Payments
 
Sec. 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.

[60 FR 26668, May 18, 1995]