Pennsylvania Code
Title 34 - LABOR AND INDUSTRY
Part VIII - Bureau of Workers' Compensation
Chapter 127 - WORKERS' COMPENSATION MEDICAL COST CONTAINMENT
Subchapter B - MEDICAL FEES AND FEE REVIEW
CALCULATIONS
Section 127.125 - ASCs
Universal Citation: 34 PA Code ยง 127.125
Current through Register Vol. 54, No. 38, September 21, 2024
Payments to providers of outpatient surgery in an ASC, shall be based on the ASC payment groups defined by HCFA, and shall include the Medicare list of covered services and related classifications in these groups. This payment amount shall be multiplied by 113%. For surgical procedures not included in the Medicare list of covered services, payments shall be based on 80% of the usual and customary charge.
This section cited in 34 Pa. Code § 127.101 (relating to medical fee caps-Medicare); and 34 Pa. Code § 127.159 (relating to medical fee updates on and after January 1, 1995-ASCs).
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