Section 127.101. Medical fee caps—Medicare

Section 127.102. Medical fee caps—usual and customary charge

Section 127.103. Outpatient providers subject to the Medicare fee schedule—generally

Section 127.104. Outpatient providers subject to the Medicare fee schedule—physicians

Section 127.105. Outpatient providers subject to the Medicare fee schedule—chiropractors

Section 127.106. Outpatient providers subject to the Medicare fee schedule—spinal manipulation performed by Doctors of Osteopathic Medicine

Section 127.107. Outpatient providers subject to the Medicare fee schedule—physical therapy centers and independent physical therapists

Section 127.108. Durable medical equipment and home infusion therapy

Section 127.109. Supplies and services not covered by fee schedule

Section 127.110. Inpatient acute care providers—generally

Section 127.111. Inpatient acute care providers—DRG payments

Section 127.112. Inpatient acute care providers—capital-related costs

Section 127.113. Inpatient acute care providers—medical education costs

Section 127.114. Inpatient acute care providers—outliers

Section 127.115. Inpatient acute care providers—disproportionate-share hospitals

Section 127.116. Inpatient acute care providers—Medicare-dependent small rural hospitals, sole-community hospitals and Medicare-geographically reclassified hospitals

Section 127.117. Outpatient acute care providers, specialty hospitals and other cost-reimbursed providers not subject to the Medicare fee schedule

Section 127.118. RCCs—generally

Section 127.119. Payments for services using RCCs

Section 127.120. RCCs—comprehensive outpatient rehabilitation facilities (CORFs) and outpatient physical therapy centers

Section 127.121. Cost-reimbursed providers—medical education costs

Section 127.122. Skilled nursing facilities

Section 127.123. Hospital-based and freestanding home health care providers

Section 127.124. Outpatient and end-stage renal dialysis payment

Section 127.125. ASCs

Section 127.126. New providers

Section 127.127. Mergers and acquisitions

Section 127.128. Trauma centers and burn facilities—exemption from fee caps

Section 127.129. Out-of-State medical treatment

Section 127.130. Special reports

Section 127.131. Payments for prescription drugs and pharmaceuticals—generally

Section 127.132. Payments for prescription drugs and pharmaceuticals—direct payment

Section 127.133. Payments for prescription drugs and pharmaceuticals—effect of denial of coverage by insurers

Section 127.134. Payments for prescription drugs and pharmaceuticals—ancillary services of health care providers

Section 127.135. Payments for prescription drugs and pharmaceuticals—drugs dispensed at a physician’s office

Section 127.151. Medical fee updates prior to January 1, 1995—generally

Section 127.152. Medical fee updates on and after January 1, 1995—generally

Section 127.153. Medical fee updates on and after January 1, 1995—outpatient providers, services and supplies subject to the Medicare fee schedule

Section 127.154. Medical fee updates on and after January 1, 1995—inpatient acute care providers subject to DRGs plus add-on payments

Section 127.155. Medical fee updates on and after January 1, 1995—outpatient acute care providers, specialty hospitals and other cost-reimbursed providers

Section 127.156. Medical fee updates on and after January 1, 1995—skilled nursing facilities

Section 127.157. Medical fee updates on and after January 1, 1995—home health care providers

Section 127.158. Medical fee updates on and after January 1, 1995—outpatient and end-stage renal dialysis

Section 127.159. Medical fee updates on and after January 1, 1995—ASCs

Section 127.160. Medical fee updates on and after January 1, 1995—trauma centers and burn facilities

Section 127.161. Medical fee updates on and after January 1, 1995—prescription drugs and pharmaceuticals

Section 127.162. Medical fee updates on and after January 1, 1995—new allowances adopted by Commissioner

Section 127.201. Medical bills—standard forms

Section 127.202. Medical bills—use of alternative forms

Section 127.203. Medical bills—submission of medical reports

Section 127.204. Fragmenting or unbundling of charges by providers

Section 127.205. Calculation of amount of payment due to providers

Section 127.206. Payment of medical bills—request for additional documentation

Section 127.207. Downcoding by insurers

Section 127.208. Time for payment of medical bills

Section 127.209. Explanation of benefits paid

Section 127.210. Interest on untimely payments

Section 127.211. Balance billing prohibited

Section 127.251. Medical fee disputes—review by the Bureau

Section 127.252. Application for fee review—filing and service

Section 127.253. Application for fee review—documents required generally

Section 127.254. Downcoding disputes

Section 127.255. Premature applications for fee review

Section 127.256. Administrative decision on an application for fee review

Section 127.257. Contesting an administrative decision on a fee review

Section 127.258. Bureau as intervenor

Section 127.259. Fee review hearing

Section 127.260. Fee review adjudications

Section 127.261. Further appeal rights

Section 127.301. Referral standards

Section 127.302. Resolution of self-referral disputes by Bureau