US No Surprises Act (42 USC 300gg-111 to 300gg-139) and 45 CFR Part 149 149.140(c): Derive the qualifying payment amount from the median contracted rate, index it annually by the CPI-U, and use eligible databases or new-code rules where contracted rates are insufficient

What does 149.140(c) require?

For an item or service furnished in a later year the QPA is the median contracted rate for 2019 increased by the combined percentage increase in the consumer price index for all urban consumers for each year through the year of service, rounded as the rules prescribe; for the first sufficient information year or a newly covered item or service the median of the first year is indexed from that year; where the plan lacks sufficient information it must use an eligible database (a State all-payer claims database or an independent third-party database not controlled by an issuer or provider) and may not later switch databases without cause; for new service codes the QPA is derived from the related service code or the eligible database until contracted rates exist; air ambulance QPAs follow the same method by air mileage and vehicle type and by point of pick-up region. Plans may not downcode a claim and then calculate the QPA on the altered code without disclosing the downcoding.