Fee Schedules Archives - Managed Care Contracting

State Laws

Search state statutes and regulations in all 50 states and the District of Columbia to find out what rights you have in your state and what other states are doing to empower physicians and patients in the face of health insurer market power.

Payment Issues

Network Issues

Contract Changes / Disputes

Coverage / Utilization Review

Claims Processing

State Law

Texas Statutes-Insurance Code-Title 8-Subtitle F-Chapter 1458. Subchapters A and C.

07/17/2023 Texas Sections 1458.001, 1458.101 and 1458.102

General definitions; Contract requirements; Contract access

Fee Schedules, Most Favored Nation, Rental Networks

State Law

Maryland Statutes-Article 15. Insurance

08/07/2023 Maryland Section 15-113

Health Insurance – Two–Sided Incentive Arrangements

Amendments, Fee Schedules, Overpayments / Recoupments, Participation in Products, Plans, or Networks, Payment Edits, Payment Rules, Prohibited financial incentives, Prompt Payment Deadlines, Risk—Physicians Taking

Ama Policy

Improper Use of AMA-CPT by Carriers/Software Programs H-70.954

01/03/2022

Fee Schedules, Payment Edits

Ama Policy

Physician Payment Reform H-400.972

01/03/2022

Fee Schedules

Ama Policy

Reimbursement for Allied Health Personnel H-35.992

12/30/2021

Fee Schedules

Ama Policy

Managed Care Plans and the Right to Set Fees H-383.994

12/30/2021

Our AMA opposes any government or hospital requirement that a hospital-based physician must accept the terms of any managed care plan accepted by the hospital.

Policy Timeline

Sub. Res. 704, A-01 Reaffirmed: CMS Rep. 7, A-11 Reaffirmed: CMS Rep. 1, A-21

Fee Schedules

Ama Policy

CPT Coding System H-70.974

Fee Schedules

Ama Policy

Insurance Coverage for Immunizations H-185.969

12/30/2021

Fee Schedules

Ama Policy

Insurance Industry Behaviors D-385.949

08/30/2022

Fee Schedules

Ama Policy

Coverage of Emergency Services D-130.989

12/30/2021

Fee Schedules