Pennsylvania Code
Pennsylvania Code & Bulletin
COMMONWEALTH OF PENNSYLVANIA

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The Pennsylvania Code website reflects the Pennsylvania Code changes effective through 54 Pa.B. 5598 (August 31, 2024).

34 Pa. Code § 127.130. Special reports.

§ 127.130. Special reports.

 (a)  Payments shall be made for special reports (CPT code 99080) only if these reports are specifically requested by the insurer. Office notes and other documentation which are necessary to support provider codes billed may not be considered special reports.

 (b)  Payments for special reports shall be at 80% of the provider’s usual and customary charge.

 (c)  The Bureau-prescribed report required by §  127.203 (relating to medical bills—submission of medical reports) may not be considered a special report that is chargeable under this section.


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