Sec. 10.11.03.14. Billing Procedures for Physician Office Services

A. A physician shall:

(1) Comply with all procedures listed in Regulation .13 of this chapter;

(2) Charge the CMS Program the usual and customary charge to the general public for similar services; and

(3) Bill the CMS Program as specified by the CMS Program.

B. The CMS Program shall:

(1) Use the fee schedule contained in the Maryland Medical Assistance Program’s Professional Services Provider Manual and Fee Schedule, which is incorporated by reference in COMAR 10.09.02.07D;

(2) Pay for covered services that are the lower of the:

(a) Physician’s customary charge; or

(b) Department's fee schedule;

(3) Reimburse the provider for:

(a) Dispensed drugs at rates established by COMAR 10.09.03; and

(b) Injectable drugs at rates promulgated by the Professional Services Provider Manual and Fee Schedule referenced in §B(1) of this regulation.

C. The CMS Program reserves the right to negotiate and establish a different fee for the physician or the group of physicians under contract to a hospital to provide services when a portion of the cost of the contract is paid as the hospital’s cost.