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
REVIEW OF MEDICAL FEE DISPUTES
Section 127.254 - Downcoding disputes
Universal Citation: 34 PA Code ยง 127.254
Current through Register Vol. 54, No. 38, September 21, 2024
(a) When changes in procedure codes are the basis for a fee dispute, the Bureau will give the provider and the insurer the opportunity to produce copies of written communications concerning the changes in procedure codes.
(b) If an insurer has not complied with § 127.207 (relating to downcoding by insurers) the Bureau will resolve downcoding disputes in favor of the provider.
This section cited in 34 Pa. Code § 127.207 (relating to downcoding by insurers).
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