{"data":{"id":"us-in/ic-16-51-1-11","jurisdiction":"us-in","citation":"IC 16-51-1-11","heading":"Individual provider form required; place of service codes; physician fee schedule","body":"Sec. 11. (a) As used in this section, \"physician fee schedule\" refers to the negotiated agreement between a payor and a qualified provider specifying reimbursement for services furnished in an office setting and billed on a CMS 1500 form or its electronic equivalent.\n(b) A bill for health care services provided by a qualified provider in an office setting:\n(1) may not be submitted on an institutional provider form; and\n(2) must be submitted on an individual provider form.\n(c) A payor shall not accept a bill for health care services that is submitted on an institutional provider form.\n(d) A qualified provider in an office setting may not bill health care services with a place of service code 21 or 22, as published in the place of service code set maintained by the federal Centers for Medicare and Medicaid Services.\n(e) Beginning January 1, 2026, a payor shall pay the claims incurred by an in-network qualified provider based on the physician fee schedule.","path":["TITLE 16. HEALTH","ARTICLE 51. HEALTH CARE REQUIREMENTS","Chapter 1. Health Care Billing"],"source_url":"https://iga.in.gov/ic/2026/Title_16.html#16-51-1-11","current_through":"2026","vintage":"2026","retrieved_at":"2026-09-11T20:02:18Z","sha256":"36eab18a136d821ebcbe93b9f375ccaf86e211f6050b08631aeb901ab6ddf076","source_id":"us-in","stale":false,"prev":"us-in/ic-16-51-1-10.5","next":"us-in/ic-16-51-1-11.1"},"notice":"GroundRules: Original legal text. Not legal advice."}