SECTION 42.140. Amount of Payment

(a) General. A provider will be paid an amount that is fair and reasonable. It shall be presumed that fair and reasonable amounts are those established in the fee guidelines. Any adjudication by the board as to fair and reasonable amount will be consistent with fee guidelines unless evidence has been properly filed with the board indicating that a different amount is fair and reasonable. The board will consider any request for payment in excess of the fee guidelines when filed by report.

(b) Payment for services billed by report. The carrier shall base payment for services billed by report upon review of the submitted documentation and recommendations from the carrier's medical consultant.

Source Note: The provisions of this §42.140 adopted to be effective October 20, 1988, 13 TexReg 4994.