Indiana § 16-51-1-11 - Individual provider form required; place of service codes; physician fee schedule
Full text of Indiana Indiana Code § 16-51-1-11 — Individual provider form required; place of service codes; physician fee schedule, with citation guidance and answers to common questions.
§ 16-51-1-11. Individual provider form required; place of service codes; physician fee schedule
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.
(b) A bill for health care services provided by a qualified provider in an office setting:
(1) may not be submitted on an institutional provider form; and
(2) must be submitted on an individual provider form.
(c) A payor shall not accept a bill for health care services that is submitted on an institutional provider form.
(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.
(e) Beginning January 1, 2026, a payor shall pay the claims incurred by an in-network qualified provider based on the physician fee schedule.
As added by P.L.203-2023, SEC.18. Amended by P.L.213-2025, SEC.157; P.L.215-2025, SEC.36.
Source: official Indiana text · Last verified 2026-08-27
Frequently Asked Questions About Indiana § 16-51-1-11
What does Indiana Code § 16-51-1-11 cover?
Section 16-51-1-11 ("Individual provider form required; place of service codes; physician fee schedule") is part of the Indiana Code, the codified statutory law of Indiana. It sets out the legal rule or procedure described in the text above. Statutes are amended regularly, so always verify against the official source.
How do I cite Indiana § 16-51-1-11?
A common citation format is "Indiana Code § 16-51-1-11" (Indiana). Legal writing may require the code abbreviation, section number, and year or edition. Match the style required by your court, professor, or publisher.
Is this the official text of Indiana law?
No. This page is for research and education and may not include the most recent amendments. For official current law, check the Indiana official source linked on this page or consult a licensed Indiana attorney.
How does Indiana § 16-51-1-11 apply to my situation?
Statutes are interpreted in context, and application depends on your specific facts. Only a licensed attorney in Indiana can advise on how this section applies to you. Contact your state or local bar association for a referral.
Sources & Verification
Not legal advice. Verify against the official source and consult a licensed attorney in Indiana.