Regulations last checked for updates: Feb 09, 2026

Title 42 - Public Health last revised: Feb 02, 2026
§ 405.920 - Initial determinations.

After a claim is filed with the appropriate contractor in the manner and form described in subpart C of part 424 of this chapter, the contractor must—

(a) Determine if the items and services furnished are covered or otherwise reimbursable under title XVIII of the Act;

(b) Determine any amounts payable and make payment accordingly; and

(c) Notify the parties to the initial determination of the determination in accordance with § 405.921.

cite as: 42 CFR 405.920