Pennsylvania Code & Bulletin

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The Pennsylvania Code website reflects the Pennsylvania Code changes effective through 53 Pa.B. 696 (January 28, 2023).

34 Pa. Code § 127.102. Medical fee caps—usual and customary charge.

§ 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.

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