Ch. 9                                             1993 LAWS OF MARYLAND

DOES NOT DUPLICATE INFORMATION COLLECTED BY THE HEALTH SERVICES COST
REVIEW COMMISSION HOSPITAL DISCHARGE DATA BASE, OR DATA COLLECTED BY
THE HEALTH RESOURCES PLANNING COMMISSION AS AUTHORIZED IN § 19-107 OF THIS
TITLE.

(H) (1) IF A PHYSICIAN'S BILL OR REQUEST FOR PAYMENT FOR A PHYSICIAN'S
SERVICES INCLUDES A CHARGE TO A PATIENT FOR A DIAGNOSTIC TEST FOR WHICH
PAYMENT MAY BE MADE BY A PAYOR, THE AMOUNT PAYABLE WITH RESPECT TO THE
TEST SHALL BE DETERMINED AS FOLLOWS:

(I) IF THE BILL OR REQUEST FOR PAYMENT INDICATES THAT THE
PHYSICIAN WHO SUBMITTED THE BILL, OR FOR WHOSE SERVICES THE REQUEST FOR
PAYMENT WAS MADE, PERSONALLY PERFORMED OR SUPERVISED THE PERFORMANCE OF
THE TEST OR THAT ANOTHER PHYSICIAN WITH WHOM THE PHYSICIAN SHARES THE
PRACTICE PERSONALLY PERFORMED OR SUPERVISED THE TEST, THE PAYMENT SHALL
BE THE REASONABLE CHARGE FOR THE TEST LESS THE APPLICABLE DEDUCTIBLE AND
COINSURANCE AMOUNTS; OR

(II) IF THE BILL OR REQUEST FOR PAYMENT INDICATES THAT THE
TEST WAS PERFORMED BY ANOTHER PROVIDER OR AN OFFICE FACILITY, IDENTIFIES
THE PROVIDER OR OFFICE FACILITY, AND INDICATES THE AMOUNT THE PROVIDER OR
OFFICE FACILITY CHARGED THE PHYSICIAN WHO SUBMITTED THE BILL OR FOR WHOSE
SERVICES THE REQUEST FOR PAYMENT WAS MADE, PAYMENT FOR THE TEST SHALL BE
THE LOWER OF:

1. THE PROVIDER'S OR OFFICE FACILITY'S USUAL, CUSTOMARY
AND REASONABLE CHARGE FOR THE TEST; OR

2. THE AMOUNT THE PROVIDER OR OFFICE FACILITY
CHARGED THE PHYSICIAN FOR THE TEST, PLUS A NOMINAL FEE, WHERE THE PHYSICIAN
BILLS FOR SUCH A SERVICE, TO COVER THE PHYSICIAN'S COSTS IN COLLECTING AND
HANDLING THE SAMPLE ON WHICH THE TEST WAS PERFORMED LESS THE APPLICABLE
DEDUCTIBLE AND COINSURANCE AMOUNTS.

(2) A PAYOR MAY REFUSE PAYMENT OF A BILL, IF THE BILL OR REQUEST
FOR A PAYMENT:

(I) AS PROVIDED UNDER PARAGRAPH (1)(II)1 OF THIS SUBSECTION,
DOES NOT INDICATE WHO PERFORMED THE TEST; OR

(II) AS PROVIDED UNDER PARAGRAPH (1)(II)2 OF THIS SUBSECTION,
INDICATES THAT THE TEST WAS PERFORMED BY A PROVIDER OR OFFICE FACILITY BUT
DOES NOT IDENTIFY THE PROVIDER OR OFFICE FACILITY OR INCLUDE THE AMOUNT
CHARGED BY THE PROVIDER OR OFFICE FACILITY.

(3) A PHYSICIAN MAY NOT BILL:

(I) FOR ANY AMOUNT OTHER THAN THE PAYMENT AMOUNT
SPECIFIED UNDER PARAGRAPH (1) OF THIS SUBSECTION AND ANY APPLICABLE
DEDUCTIBLE AND COINSURANCE FOR A DIAGNOSTIC TEST FOR WHICH PAYMENT IS
MADE PURSUANT TO PARAGRAPH (1)(I) OF THIS SECTION; OR

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