Current through Register 1527, August 2, 2024
Section 401.418 - Maximum Allowable Fees(A) The Division of Health Care Finance and Policy (DHCFP) determines the maximum allowable fees for independent clinical laboratory services. The maximum allowable payment for a service is the lowest of the following: (1) the amount listed in the applicable DHCFP fee schedule;(2) the independent clinical laboratory's usual and customary fee; or(3) the amount that would be recognized under 42 U.S.C. § 13951(h) for tests performed for a person with Medicare Part B benefits.(B) The maximum allowable payment is full compensation for the laboratory service and any related administrative or supervisory duties in connection with the service, regardless of where the service was provided.(C) An independent clinical laboratory cannot bill for more than its usual and customary fee for a service.