Code of Maryland Regulations
Title 31 - MARYLAND INSURANCE ADMINISTRATION
Subtitle 12 - HEALTH MAINTENANCE ORGANIZATIONS; ENTITIES THAT ACT AS HEALTH INSURERS
Chapter 31.12.08 - Payments to Nonparticipating Providers
Section 31.12.08.02 - Definitions

(1) "Berenson-Eggers Type of Service Code" has the meaning stated in Health-General Article, §19-710.1, Annotated Code of Maryland.

(2) "CPT code" means the Current Procedural Terminology Code maintained and distributed by the American Medical Association, including its codes and modifiers, and codes for anesthesia services.

(3) "Enrollee" has the meaning stated in Health-General Article, §19-710.1, Annotated Code of Maryland.

(4) "Evaluation and management services" has the meaning stated in Health-General Article, §19-710.1, Annotated Code of Maryland.

(5) "Geographic area" means each geographic area as published by the Centers for Medicare and Medicaid Services.

(6) "HCPCS" means the Healthcare Common Procedure Coding System, a set of health care procedure codes based on the American Medical Association's Current Procedural Terminology and other services such as ambulance services, prosthetic devices, other supplies, and non-physician services that are not covered by CPT codes but are recognized and maintained by the Centers for Medicare and Medicaid Services.

(7) "Health maintenance organization" has the meaning stated in Health-General Article, §19-701, Annotated Code of Maryland.

(8) "Medicare Economic Index" has the meaning stated in Health-General Article, §19-710.1, Annotated Code of Maryland.

(9) "Nonparticipating provider" means a provider other than a hospital or trauma physician who is not included on the provider panel of a health maintenance organization.

(10) "Participating provider" means a provider other than a hospital or trauma physician who is included on the provider panel of a health maintenance organization.

(11) "Provider" means a health care practitioner licensed, certified, or otherwise authorized by law to provide health care services.

(12) "Provider panel" has the meaning stated in Insurance Article, § 15-112, Annotated Code of Maryland.

(13) "Reference year" means, for services provided in a particular calendar year, the period beginning with July 1 of the second previous calendar year through June 30 of the previous calendar year.

(14) "Similarly licensed provider" has the meaning stated in Health-General Article, §19-710.1, Annotated Code of Maryland.

(15) "Trauma physician" has the meaning stated in Health-General Article, §19-710.1, Annotated Code of Maryland.