{"data":{"id":"us/42-cfr-478.10","jurisdiction":"us","citation":"42 CFR 478.10","heading":"Scope.","body":"This subpart establishes the requirements and procedures for—\n(a) Reconsiderations conducted by a Utilization and Quality Control Quality Improvement Organization (QIO) or its subcontractor of initial denial determinations concerning services furnished or proposed to be furnished under Medicare;\n(b) Hearings and judicial review of reconsidered determinations; and\n(c) QIO review of a change in diagnostic and procedural coding information.","path":["Title 42—Public Health","CHAPTER IV—CENTERS FOR MEDICARE \u0026 MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES","SUBCHAPTER F—QUALITY IMPROVEMENT ORGANIZATIONS","PART 478—RECONSIDERATIONS AND APPEALS","Subpart B—Utilization and Quality Control Quality Improvement Organization (QIO) Reconsiderations and Appeals"],"source_url":"https://www.ecfr.gov/api/versioner/v1/full/2026-08-25/title-42.xml","current_through":"2026-08-25","vintage":"","retrieved_at":"2026-08-27T02:26:11Z","sha256":"a49b1e7ab7e6f67ef6dc722301be6fb75e37d3f8ae7c4a68ada8567cfc04bf83","source_id":"us-cfr","stale":true,"prev":"us/42-cfr-476.170","next":"us/42-cfr-478.12"},"notice":"GroundRules: Original legal text. Not legal advice."}