{"data":{"id":"us/42-cfr-411.53","jurisdiction":"us","citation":"42 CFR 411.53","heading":"Basis for conditional Medicare payment in no-fault cases.","body":"(a) A conditional Medicare payment may be made in no-fault cases under either of the following circumstances:\n(1) The beneficiary has filed a proper claim for no-fault insurance benefits but the intermediary or carrier determines that the no-fault insurer will not pay promptly for any reason other than the circumstances described in § 411.32(a)(1). This includes cases in which the no-fault insurance carrier has denied the claim.\n(2) The beneficiary, because of physical or mental incapacity, failed to meet a claim-filing requirement stipulated in the policy.\n(b) Any conditional payment that CMS makes is conditioned on reimbursement to CMS in accordance with subpart B of this part.","path":["Title 42—Public Health","CHAPTER IV—CENTERS FOR MEDICARE \u0026 MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES","SUBCHAPTER B—MEDICARE PROGRAM","PART 411—EXCLUSIONS FROM MEDICARE AND LIMITATIONS ON MEDICARE PAYMENT","Subpart D—Limitations on Medicare Payment for Services Covered Under Liability or No-Fault Insurance"],"source_url":"https://www.ecfr.gov/api/versioner/v1/full/2026-08-25/title-42.xml","current_through":"2026-08-25","vintage":"","retrieved_at":"2026-08-27T02:26:11Z","sha256":"44fd464124eb6a52cc550e0cc6b6c2bedb4285778e8ba76e1cf7130fedd3ba37","source_id":"us-cfr","stale":true,"prev":"us/42-cfr-411.52","next":"us/42-cfr-411.54"},"notice":"GroundRules: Original legal text. Not legal advice."}