1. (a) As used in this section, "physician fee schedule" refers to the negotiated agreement between a payor and a qualified provider specifying reimbursement for services furnished in an office setting and billed on a CMS 1500 form or its electronic equivalent.

2. (b) A bill for health care services provided by a qualified provider in an office setting:

   1. (1) may not be submitted on an institutional provider form; and
   2. (2) must be submitted on an individual provider form.
3. (c) A payor shall not accept a bill for health care services that is submitted on an institutional provider form.
4. (d) A qualified provider in an office setting may not bill health care services with a place of service code 21 or 22, as published in the place of service code set maintained by the federal Centers for Medicare and Medicaid Services.
5. (e) Beginning January 1, 2026, a payor shall pay the claims incurred by an in-network qualified provider based on the physician fee schedule.

As added by P.L.203-2023, SEC.18. Amended by P.L.213-2025, SEC.157; P.L.215-2025, SEC.36.