34 Pa. Code § 127.406 - Scope of review of UROs
(a)
UROs shall decide only the reasonableness or necessity of the treatment under
review.
(b) UROs may not decide any
of the following issues:
(1) The causal
relationship between the treatment under review and the employe's work-related
injury.
(2) Whether the employe is
still disabled.
(3) Whether
"maximum medical improvement" has been obtained.
(4) Whether the provider performed the
treatment under review as a result of an unlawful self-referral.
(5) The reasonableness of the fees charged by
the provider.
(6) The
appropriateness of the diagnostic or procedural codes used by the provider for
billing purposes.
(7) Other issues
which do not directly relate to the reasonableness or necessity of the
treatment under review.
Notes
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