31 Pa. Code § 69.24
Current through Register Vol. 54, No. 40, October 5, 2024
A provider may not fragment or unbundle charges imposed for specific care except as consistent with the Medicare Program. Changes to a provider's codes by an insurer shall be made only as consistent with the Medicare Program and when the insurer has sufficient information to make the changes and following consultation with the provider. An insurer shall substantiate the reasons for coding changes to the provider in writing.
31 Pa. Code § 69.24