US No Surprises Act (42 USC 300gg-111 to 300gg-139) and 45 CFR Part 149 149.140(a)-(b): Calculate the median contracted rate for each item or service by service code, provider specialty, facility type, insurance market and geographic region

What does 149.140(a)-(b) require?

The qualifying payment amount rests on the median of the contracted rates the plan or issuer (or all plans of the sponsor in the same insurance market) had on 31 January 2019 with participating providers in the same or similar specialty, or facilities of the same type, for the same or similar item or service, in the geographic region (each metropolitan statistical area in a State and the rest of the State, widening to all MSAs in the State and then the Census division when fewer than three contracted rates exist). Each contract counts as one rate regardless of claim volume; rates varying by modifier or site of service are separated; single case agreements do not count; and a plan has sufficient information only with at least three contracted rates. Underlying fee schedule rates are used where they, not the contracted rate, determine cost sharing.