34 Pa. Code § 127.102

Current through Register Vol. 54, No. 50, December 14, 2024

Section 127.102 - Medical fee caps-usual and customary charge

If a Medicare payment mechanism does not exist for a particular treatment, accommodation, product or service, the amount of the payment made to a health care provider shall be either 80% of the usual and customary charge for that treatment, accommodation, product or service in the geographic area where rendered, or the actual charge, whichever is lower.

34 Pa. Code § 127.102