Code of Maryland Regulations
Title 10 - MARYLAND DEPARTMENT OF HEALTH
Part 3
Subtitle 11 - MATERNAL AND CHILD HEALTH
Chapter 10.11.03 - Children's Medical Services Program
Section 10.11.03.14 - Billing Procedures for Physician Office Services
Universal Citation: MD Code Reg 10.11.03.14
Current through Register Vol. 51, No. 19, September 20, 2024
A. A physician shall:
(1) Comply with all procedures listed in
Regulation .13 of this chapter;
(2)
Charge the CMS Program the usual and customary charge to the general public for
similar services; and
(3) Bill the
CMS Program as specified by the CMS Program.
B. The CMS Program shall:
(1) Use the fee schedule contained in the
Maryland Medical Assistance Program's Professional Services Provider Manual and
Fee Schedule, which is incorporated by reference in COMAR
10.09.02.07D;
(2) Pay for covered services that are the
lower of the:
(a) Physician's customary
charge; or
(b) Department's fee
schedule;
(3) Reimburse
the provider for:
(a) Dispensed drugs at
rates established by COMAR 10.09.03; and
(b) Injectable drugs at rates promulgated by
the Professional Services Provider Manual and Fee Schedule referenced in
§B(1) of this regulation.
C. The CMS Program reserves the right to negotiate and establish a different fee for the physician or the group of physicians under contract to a hospital to provide services when a portion of the cost of the contract is paid as the hospital's cost.
Disclaimer: These regulations may not be the most recent version. Maryland may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
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