<?xml version='1.0' encoding='utf-8'?>
<regulation prefix="Regulation" num=".14" citation="COMAR 10.11.03.14" title_num="10" subtitle_num="11" chapter_num="03" heading="Billing Procedures for Physician Office Services.">
  <paragraph num="A.">
    <text>A physician shall:</text>
    <paragraph num="(1)">
      <text>Comply with all procedures listed in Regulation .13 of this chapter;</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Charge the CMS Program the usual and customary charge to the general public for similar services; and</text>
    </paragraph>
    <paragraph num="(3)">
      <text>Bill the CMS Program as specified by the CMS Program.</text>
    </paragraph>
  </paragraph>
  <paragraph num="B.">
    <text>The CMS Program shall:</text>
    <paragraph num="(1)">
      <text>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;</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Pay for covered services that are the lower of the:</text>
      <paragraph num="(a)">
        <text>Physician’s customary charge; or</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Department's fee schedule;</text>
      </paragraph>
    </paragraph>
    <paragraph num="(3)">
      <text>Reimburse the provider for:</text>
      <paragraph num="(a)">
        <text>Dispensed drugs at rates established by COMAR 10.09.03; and</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Injectable drugs at rates promulgated by the Professional Services Provider Manual and Fee Schedule referenced in §B(1) of this regulation.</text>
      </paragraph>
    </paragraph>
  </paragraph>
  <paragraph num="C.">
    <text>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.</text>
  </paragraph>
</regulation>