(a) Except as provided in paragraph (b) of this section, medical
services from an authorized provider which are payable under
Sec. 725.701 shall not require prior approval of the Office or the
responsible operator.
(b) Except where emergency treatment is required, prior approval of
the Office or the responsible operator shall be obtained before any
hospitalization or surgery, or before ordering an apparatus for
treatment where the purchase price exceeds $300. A request for approval
of non-emergency hospitalization or surgery shall be acted upon
expeditiously, and approval or disapproval will be given by telephone
if a written response cannot be given within 7 days following the
request. No employee of the Department of Labor, other than a district
director or the Chief, Branch of Medical Analysis and Services, DCMWC,
is authorized to approve a request for hospitalization or surgery by
telephone.
(c) Payment for medical services, treatment, or an apparatus shall
be made at no more than the rate prevailing in the community in which
the providing physician, medical facility or supplier is located.
