Indiana § 16-51-1-11 Individual provider form required; place of service codes; physician fee
schedule

Indiana Statutes

§ 16-51-1-11 — Individual provider form required; place of service codes; physician fee schedule

Indiana·Title 16 HEALTH·Art. 51 HEALTH CARE REQUIREMENTS·Ch. 1 Health Care Billing

(a)As used in this section, "physician fee schedule" refers to the negotiated agreement between a payor and a qualified provider specifying reimbursement for services furnished in an office setting and billed on a CMS 1500 form or its electronic equivalent.

(b)A bill for health care services provided by a qualified provider in an office setting:

(1)may not be submitted on an institutional provider form; and

(2)must be submitted on an individual provider form.

(c)A payor shall not accept a bill for health care services that is submitted on an institutional provider form.

(d)A qualified provider in an office setting may not bill health care services with a place of service code 21 or 22, as published in the place of service code set maintained by the federal Centers for Medicare and Me

Free access — add to your briefcase to read the full text and ask questions with AI

(a) As used in this section, "physician fee
schedule" refers to the negotiated agreement between a payor and a
qualified provider specifying reimbursement for services furnished in
an office setting and billed on a CMS 1500 form or its electronic
equivalent.
(b) A bill for health care services provided by a qualified provider
in an office setting:
(1) may not be submitted on an institutional provider form; and
(2) must be submitted on an individual provider form.
(c) A payor shall not accept a bill for health care services that is
submitted on an institutional provider form.
(d) A qualified provider in an office setting may not bill health care
services with a place of service code 21 or 22, as published in the place
of service code set maintained by the federal Centers for Medicare and
Medicaid Services.
(e) Beginning January 1, 2026, a payor shall pay the claims incurred
by an in-network qualified provider based on the physician fee
schedule.

Indiana § 16-51-1-11 (Individual provider form required; place of service codes; physician fee schedule) — published by Counsel Stack Legal Research, free access to 12M+ legal documents.