34 Pa. Code § 127.406

Current through Register Vol. 50, No. 49, December 5, 2020
Section 127.406 - Scope of review of UROs
(a) UROs shall decide only the reasonableness or necessity of the treatment under review.
(b) UROs may not decide any of the following issues:
(1) The causal relationship between the treatment under review and the employe's work-related injury.
(2) Whether the employe is still disabled.
(3) Whether "maximum medical improvement" has been obtained.
(4) Whether the provider performed the treatment under review as a result of an unlawful self-referral.
(5) The reasonableness of the fees charged by the provider.
(6) The appropriateness of the diagnostic or procedural codes used by the provider for billing purposes.
(7) Other issues which do not directly relate to the reasonableness or necessity of the treatment under review.

34 Pa. Code § 127.406