Pennsylvania Code
Title 34 - LABOR AND INDUSTRY
Part VIII - Bureau of Workers' Compensation
Chapter 127 - WORKERS' COMPENSATION MEDICAL COST CONTAINMENT
Subchapter C - MEDICAL TREATMENT REVIEW
UR-GENERAL REQUIREMENTS
Section 127.406 - Scope of review of UROs
Universal Citation: 34 PA Code ยง 127.406
Current through Register Vol. 54, No. 38, September 21, 2024
(a) UROs shall decide only the reasonableness or necessity of the treatment under review.
(b) UROs may not decide any of the following issues:
(1) The causal
relationship between the treatment under review and the employe's work-related
injury.
(2) Whether the employe is
still disabled.
(3) Whether
"maximum medical improvement" has been obtained.
(4) Whether the provider performed the
treatment under review as a result of an unlawful self-referral.
(5) The reasonableness of the fees charged by
the provider.
(6) The
appropriateness of the diagnostic or procedural codes used by the provider for
billing purposes.
(7) Other issues
which do not directly relate to the reasonableness or necessity of the
treatment under review.
Disclaimer: These regulations may not be the most recent version. Pennsylvania 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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