Medical Fees and Fee Review | MidpageMedical Fees and Fee Review
127.101Medical fee caps—Medicare.127.102Medical fee caps—usual and customary charge.127.103Outpatient providers subject to the Medicare fee schedule—generally.127.104Outpatient providers subject to the Medicare fee schedule—physicians.127.105Outpatient providers subject to the Medicare fee schedule—chiropractors.127.106Outpatient providers subject to the Medicare fee schedule—spinal manipulation performed by Doctors of Osteopathic Medicine.127.107Outpatient providers subject to the Medicare fee schedule—physical therapy centers and independent physical therapists.127.108Durable medical equipment and home infusion therapy.127.109Supplies and services not covered by fee schedule.127.110Inpatient acute care providers—generally.127.111Inpatient acute care providers—DRG payments.127.112Inpatient acute care providers—capital-related costs.127.113Inpatient acute care providers—medical education costs.127.114Inpatient acute care providers—outliers.127.115Inpatient acute care providers—disproportionate-share hospitals.127.116Inpatient acute care providers—Medicare-dependent small rural hospitals, sole-community hospitals and Medicare-geographically reclassified hospitals.127.117Outpatient acute care providers, specialty hospitals and other cost-reimbursed providers not subject to the Medicare fee schedule.127.118RCCs—generally.127.119Payments for services using RCCs.127.120RCCs—comprehensive outpatient rehabilitation facilities (CORFs) and outpatient physical therapy centers.127.121Cost-reimbursed providers—medical education costs.127.122Skilled nursing facilities.127.123Hospital-based and freestanding home health care providers.127.124Outpatient and end-stage renal dialysis payment.127.125ASCs.127.126New providers.127.127Mergers and acquisitions.127.128Trauma centers and burn facilities—exemption from fee caps.127.129Out-of-State medical treatment.127.130Special reports.127.131Payments for prescription drugs and pharmaceuticals—generally.127.132Payments for prescription drugs and pharmaceuticals—direct payment.127.133Payments for prescription drugs and pharmaceuticals—effect of denial of coverage by insurers.127.134Payments for prescription drugs and pharmaceuticals—ancillary services of health care providers.127.135Payments for prescription drugs and pharmaceuticals—drugs dispensed at a physician’s office.127.151Medical fee updates prior to January 1, 1995—generally.127.152Medical fee updates on and after January 1, 1995—generally.127.153Medical fee updates on and after January 1, 1995—outpatient providers, services and supplies subject to the Medicare fee schedule.127.154Medical fee updates on and after January 1, 1995—inpatient acute care providers subject to DRGs plus add-on payments.127.155Medical fee updates on and after January 1, 1995—outpatient acute care providers, specialty hospitals and other cost-reimbursed providers.127.156Medical fee updates on and after January 1, 1995—skilled nursing facilities.127.157Medical fee updates on and after January 1, 1995—home health care providers.127.158Medical fee updates on and after January 1, 1995—outpatient and end-stage renal dialysis.127.159Medical fee updates on and after January 1, 1995—ASCs.127.160Medical fee updates on and after January 1, 1995—trauma centers and burn facilities.127.161Medical fee updates on and after January 1, 1995—prescription drugs and pharmaceuticals.127.162Medical fee updates on and after January 1, 1995—new allowances adopted by Commissioner.127.201Medical bills—standard forms.127.202Medical bills—use of alternative forms.127.203Medical bills—submission of medical reports.127.204Fragmenting or unbundling of charges by providers.127.205Calculation of amount of payment due to providers.127.206Payment of medical bills—request for additionaldocumentation.127.207Downcoding by insurers.127.208Time for payment of medical bills.127.209Explanation of benefits paid.127.210Interest on untimely payments.127.211Balance billing prohibited.127.251Medical fee disputes—review by the Bureau.127.252Application for fee review—filing and service.127.253Application for fee review—documents required generally.127.254Downcoding disputes.127.255Premature applications for fee review.127.256Administrative decision on an application for fee review.127.257Contesting an administrative decision on a fee review.127.258Bureau as intervenor.127.259Fee review hearing.127.260Fee review adjudications.127.261Further appeal rights.127.301Referral standards.127.302Resolution of self-referral disputes by Bureau.