1. Regulations
  2. title 42
  3. chapter IV-i2
  4. part 476
  5. subpart C
  6. subjgrp 185
  7. § 476.83

View all text of Subjgrp 185 [§ 476.83 - § 476.170]

§ 476.83 - Initial denial determinations.

A determination by a QIO that the health care services furnished or proposed to be furnished to a patient are not medically necessary, are not reasonable, or are not at the appropriate level of care, is an initial denial determination and is appealable under part 473 of this chapter.

AUTHORITY: 42 U.S.C. 1302 and 1395hh.

SOURCE: 44 FR 32081, June 4, 1979, unless otherwise noted. Redesignated at 64 FR 66279, Nov. 24, 1999.

CITE AS: 42 CFR 476.83