---
kind: "section"
citation: "42 U.S.C. § 300gg–132"
title: "42"
title_heading: "The Public Health and Welfare"
number: "300gg–132"
heading: "Balance billing in cases of non-emergency services performed by nonparticipating providers at certain participating facilities"
release: "119-102"
date: "2026-07-12"
url: "https://uscodex.org/usc/42/300gg-132"
units:
  - "Chapter 6A — Public Health Service"
  - "Subchapter XXV — Requirements Relating to Health Insurance Coverage"
  - "Part E — Health Care Provider Requirements"
---

# §300gg–132. Balance billing in cases of non-emergency services performed by nonparticipating providers at certain participating facilities

- (a) **In general—** Subject to [subsection (b)](#b), in the case of a [participant](/usc/42/300gg–91.md?p=d-11), [beneficiary](/usc/42/300gg–91.md?p=d-2), or enrollee with benefits under a [group health plan](/usc/42/300bb–8.md?p=1) or group or [individual health insurance coverage](/usc/42/300gg–91.md?p=b-5) offered by a [health insurance issuer](/usc/42/300gg–91.md?p=b-2) and who is furnished during a plan year beginning on or after January 1, 2022, items or [services](/usc/42/201.md?p=a) (other than emergency [services](/usc/42/201.md?p=a) to which [section 300gg–131 of this title](/usc/42/300gg–131.md) applies) for which benefits are provided under the plan or coverage at a participating health care facility by a nonparticipating [provider](/usc/42/299b–21.md?p=8), such [provider](/usc/42/299b–21.md?p=8) shall not bill, and shall not hold liable, such [participant](/usc/42/300gg–91.md?p=d-11), [beneficiary](/usc/42/300gg–91.md?p=d-2), or enrollee for a payment amount for such an item or [service](/usc/42/201.md?p=a) furnished by such [provider](/usc/42/299b–21.md?p=8) with respect to a visit at such facility that is more than the cost-sharing requirement for such item or [service](/usc/42/201.md?p=a) (as determined in accordance with subparagraphs (A) and (B) of [section 300gg–111(b)(1) of this title](/usc/42/300gg–111.md?p=b-1)[^1] of [section 9816(b)(1) of title 26](/usc/26/9816.md?p=b-1), and of [section 1185e(b)(1) of title 29](/usc/29/1185e.md?p=b-1), as applicable).
- (b) **Exception—**
  - (1) **In general—** [Subsection (a)](#a) shall not apply with respect to items or [services](/usc/42/201.md?p=a) (other than ancillary [services](/usc/42/201.md?p=a) described in [paragraph (2)](#b-2)) furnished by a nonparticipating [provider](/usc/42/299b–21.md?p=8) to a [participant](/usc/42/300gg–91.md?p=d-11), [beneficiary](/usc/42/300gg–91.md?p=d-2), or enrollee of a [group health plan](/usc/42/300bb–8.md?p=1) or group or [individual health insurance coverage](/usc/42/300gg–91.md?p=b-5) offered by a [health insurance issuer](/usc/42/300gg–91.md?p=b-2), if the [provider](/usc/42/299b–21.md?p=8) satisfies the notice and consent criteria of [subsection (d)](#d).
  - (2) **Ancillary services described—** For purposes of [paragraph (1)](#b-1), ancillary [services](/usc/42/201.md?p=a) described in this paragraph are, with respect to a participating health care facility—
    - (A) subject to [paragraph (3)](#b-3), items and [services](/usc/42/201.md?p=a) related to emergency medicine, anesthesiology, pathology, radiology, and neonatology, whether or not provided by a physician or non-physician practitioner, and items and [services](/usc/42/201.md?p=a) provided by assistant surgeons, hospitalists, and intensivists;
    - (B) subject to [paragraph (3)](#b-3), diagnostic [services](/usc/42/201.md?p=a) (including radiology and laboratory [services](/usc/42/201.md?p=a));
    - (C) items and [services](/usc/42/201.md?p=a) provided by such other specialty practitioners, as the [Secretary](/usc/42/201.md?p=c) specifies through rulemaking; and
    - (D) items and [services](/usc/42/201.md?p=a) provided by a nonparticipating [provider](/usc/42/299b–21.md?p=8) if there is no participating [provider](/usc/42/299b–21.md?p=8) who can furnish such item or [service](/usc/42/201.md?p=a) at such facility.
  - (3) **Exception—** The [Secretary](/usc/42/201.md?p=c) may, through rulemaking, establish a list (and update such list periodically) of advanced diagnostic laboratory tests, which shall not be included as an ancillary [service](/usc/42/201.md?p=a) described in [paragraph (2)](#b-2) and with respect to which [subsection (a)](#a) would apply.
- (c) **Clarification—** In the case of a nonparticipating [provider](/usc/42/299b–21.md?p=8) that satisfies the notice and consent criteria of [subsection (d)](#d) with respect to an item or [service](/usc/42/201.md?p=a) (referred to in this subsection as a “covered item or [service](/usc/42/201.md?p=a)”), such notice and consent criteria may not be construed as applying with respect to any item or [service](/usc/42/201.md?p=a) that is furnished as a result of unforeseen, urgent medical needs that arise at the time such covered item or [service](/usc/42/201.md?p=a) is furnished. For purposes of the previous sentence, a covered item or [service](/usc/42/201.md?p=a) shall not include an ancillary [service](/usc/42/201.md?p=a) described in [subsection (b)(2)](#b-2).
- (d) **Notice and consent to be treated by a nonparticipating provider or nonparticipating facility—**
  - (1) **In general—** A nonparticipating [provider](/usc/42/299b–21.md?p=8) or nonparticipating facility satisfies the notice and consent criteria of this subsection, with respect to items or [services](/usc/42/201.md?p=a) furnished by the [provider](/usc/42/299b–21.md?p=8) or facility to a [participant](/usc/42/300gg–91.md?p=d-11), [beneficiary](/usc/42/300gg–91.md?p=d-2), or enrollee of a [group health plan](/usc/42/300bb–8.md?p=1) or group or [individual health insurance coverage](/usc/42/300gg–91.md?p=b-5) offered by a [health insurance issuer](/usc/42/300gg–91.md?p=b-2), if the [provider](/usc/42/299b–21.md?p=8) (or, if applicable, the participating health care facility on behalf of such [provider](/usc/42/299b–21.md?p=8)) or nonparticipating facility—
    - (A) in the case that the [participant](/usc/42/300gg–91.md?p=d-11), [beneficiary](/usc/42/300gg–91.md?p=d-2), or enrollee makes an appointment to be furnished such items or [services](/usc/42/201.md?p=a) at least 72 hours prior to the date on which the individual is to be furnished such items or [services](/usc/42/201.md?p=a), provides to the [participant](/usc/42/300gg–91.md?p=d-11), [beneficiary](/usc/42/300gg–91.md?p=d-2), or enrollee (or to an authorized representative of the [participant](/usc/42/300gg–91.md?p=d-11), [beneficiary](/usc/42/300gg–91.md?p=d-2), or enrollee) not later than 72 hours prior to the date on which the individual is furnished such items or [services](/usc/42/201.md?p=a) (or, in the case that the [participant](/usc/42/300gg–91.md?p=d-11), [beneficiary](/usc/42/300gg–91.md?p=d-2), or enrollee makes such an appointment within 72 hours of when such items or [services](/usc/42/201.md?p=a) are to be furnished, provides to the [participant](/usc/42/300gg–91.md?p=d-11), [beneficiary](/usc/42/300gg–91.md?p=d-2), or enrollee (or to an authorized representative of the [participant](/usc/42/300gg–91.md?p=d-11), [beneficiary](/usc/42/300gg–91.md?p=d-2), or enrollee) on such date the appointment is made), a written notice in paper or electronic form, as selected by the [participant](/usc/42/300gg–91.md?p=d-11), [beneficiary](/usc/42/300gg–91.md?p=d-2), or enrollee, (and including electronic notification, as practicable) specified by the [Secretary](/usc/42/201.md?p=c), not later than July 1, 2021, through guidance (which shall be updated as determined necessary by the [Secretary](/usc/42/201.md?p=c)) that—
      - (i) contains the information required under [paragraph (2)](#d-2);
      - (ii) clearly [states](/usc/42/201.md?p=f) that consent to receive such items and [services](/usc/42/201.md?p=a) from such nonparticipating [provider](/usc/42/299b–21.md?p=8) or nonparticipating facility is optional and that the [participant](/usc/42/300gg–91.md?p=d-11), [beneficiary](/usc/42/300gg–91.md?p=d-2), or enrollee may instead seek care from a participating [provider](/usc/42/299b–21.md?p=8) or at a participating facility, with respect to such plan or coverage, as applicable, in which case the cost-sharing responsibility of the [participant](/usc/42/300gg–91.md?p=d-11), [beneficiary](/usc/42/300gg–91.md?p=d-2), or enrollee would not exceed such responsibility that would apply with respect to such an item or [service](/usc/42/201.md?p=a) that is furnished by a participating [provider](/usc/42/299b–21.md?p=8) or participating facility, as applicable with respect to such plan; and
      - (iii) is available in the 15 most common languages in the geographic region of the applicable facility;
    - (B) obtains from the [participant](/usc/42/300gg–91.md?p=d-11), [beneficiary](/usc/42/300gg–91.md?p=d-2), or enrollee (or from such an authorized representative) the consent described in [paragraph (3)](#d-3) to be treated by a nonparticipating [provider](/usc/42/299b–21.md?p=8) or nonparticipating facility; and
    - (C) provides a signed copy of such consent to the [participant](/usc/42/300gg–91.md?p=d-11), [beneficiary](/usc/42/300gg–91.md?p=d-2), or enrollee through mail or email (as selected by the [participant](/usc/42/300gg–91.md?p=d-11), [beneficiary](/usc/42/300gg–91.md?p=d-2), or enrollee).
  - (2) **Information required under written notice—** For purposes of [paragraph (1)(A)(i)](#d-1-A-i), the information described in this paragraph, with respect to a nonparticipating [provider](/usc/42/299b–21.md?p=8) or nonparticipating facility and a [participant](/usc/42/300gg–91.md?p=d-11), [beneficiary](/usc/42/300gg–91.md?p=d-2), or enrollee of a [group health plan](/usc/42/300bb–8.md?p=1) or group or [individual health insurance coverage](/usc/42/300gg–91.md?p=b-5) offered by a [health insurance issuer](/usc/42/300gg–91.md?p=b-2), is each of the following:
    - (A) Notification, as applicable, that the [health care provider](/usc/42/300aa–33.md?p=1) is a nonparticipating [provider](/usc/42/299b–21.md?p=8) with respect to the health plan or the health care facility is a nonparticipating facility with respect to the health plan.
    - (B) Notification of the good faith estimated amount that such [provider](/usc/42/299b–21.md?p=8) or facility may charge the [participant](/usc/42/300gg–91.md?p=d-11), [beneficiary](/usc/42/300gg–91.md?p=d-2), or enrollee for such items and [services](/usc/42/201.md?p=a) involved, including a notification that the provision of such estimate or consent to be treated under [paragraph (3)](#d-3) does not constitute a contract with respect to the charges estimated for such items and [services](/usc/42/201.md?p=a).
    - (C) In the case of a participating facility and a nonparticipating [provider](/usc/42/299b–21.md?p=8), a list of any participating [providers](/usc/42/299b–21.md?p=8) at the facility who are able to furnish such items and [services](/usc/42/201.md?p=a) involved and notification that the [participant](/usc/42/300gg–91.md?p=d-11), [beneficiary](/usc/42/300gg–91.md?p=d-2), or enrollee may be referred, at their option, to such a participating [provider](/usc/42/299b–21.md?p=8).
    - (D) Information about whether prior authorization or other care management limitations may be required in advance of receiving such items or [services](/usc/42/201.md?p=a) at the facility.
  - (3) **Consent described to be treated by a nonparticipating provider or nonparticipating facility—** For purposes of [paragraph (1)(B)](#d-1-B), the consent described in this paragraph, with respect to a [participant](/usc/42/300gg–91.md?p=d-11), [beneficiary](/usc/42/300gg–91.md?p=d-2), or enrollee of a [group health plan](/usc/42/300bb–8.md?p=1) or group or [individual health insurance coverage](/usc/42/300gg–91.md?p=b-5) offered by a [health insurance issuer](/usc/42/300gg–91.md?p=b-2) who is to be furnished items or [services](/usc/42/201.md?p=a) by a nonparticipating [provider](/usc/42/299b–21.md?p=8) or nonparticipating facility, is a document specified by the [Secretary](/usc/42/201.md?p=c), in consultation with the [Secretary](/usc/42/201.md?p=c) of Labor, through guidance that shall be signed by the [participant](/usc/42/300gg–91.md?p=d-11), [beneficiary](/usc/42/300gg–91.md?p=d-2), or enrollee before such items or [services](/usc/42/201.md?p=a) are furnished and that—
    - (A) acknowledges (in clear and understandable language) that the [participant](/usc/42/300gg–91.md?p=d-11), [beneficiary](/usc/42/300gg–91.md?p=d-2), or enrollee has been—
      - (i) provided with the written notice under [paragraph (1)(A)](#d-1-A);
      - (ii) informed that the payment of such charge by the [participant](/usc/42/300gg–91.md?p=d-11), [beneficiary](/usc/42/300gg–91.md?p=d-2), or enrollee may not accrue toward meeting any limitation that the plan or coverage places on cost-sharing, including an explanation that such payment may not apply to an in-network deductible applied under the plan or coverage; and
      - (iii) provided the opportunity to receive the written notice under [paragraph (1)(A)](#d-1-A) in the form selected by the [participant](/usc/42/300gg–91.md?p=d-11), [beneficiary](/usc/42/300gg–91.md?p=d-2) or enrollee; and
    - (B) documents the date on which the [participant](/usc/42/300gg–91.md?p=d-11), [beneficiary](/usc/42/300gg–91.md?p=d-2), or enrollee received the written notice under [paragraph (1)(A)](#d-1-A) and the date on which the individual signed such consent to be furnished such items or [services](/usc/42/201.md?p=a) by such [provider](/usc/42/299b–21.md?p=8) or facility.
  - (4) **Rule of construction—** The consent described in [paragraph (3)](#d-3), with respect to a [participant](/usc/42/300gg–91.md?p=d-11), [beneficiary](/usc/42/300gg–91.md?p=d-2), or enrollee of a [group health plan](/usc/42/300bb–8.md?p=1) or group or [individual health insurance coverage](/usc/42/300gg–91.md?p=b-5) offered by a [health insurance issuer](/usc/42/300gg–91.md?p=b-2), shall constitute only consent to the receipt of the information provided pursuant to this subsection and shall not constitute a contractual agreement of the [participant](/usc/42/300gg–91.md?p=d-11), [beneficiary](/usc/42/300gg–91.md?p=d-2), or enrollee to any estimated charge or amount included in such information.
- (e) **Retention of certain documents—** A nonparticipating facility (with respect to such facility or any nonparticipating [provider](/usc/42/299b–21.md?p=8) at such facility) or a participating facility (with respect to nonparticipating [providers](/usc/42/299b–21.md?p=8) at such facility) that obtains from a [participant](/usc/42/300gg–91.md?p=d-11), [beneficiary](/usc/42/300gg–91.md?p=d-2), or enrollee of a [group health plan](/usc/42/300bb–8.md?p=1) or group or [individual health insurance coverage](/usc/42/300gg–91.md?p=b-5) offered by a [health insurance issuer](/usc/42/300gg–91.md?p=b-2) (or an authorized representative of such [participant](/usc/42/300gg–91.md?p=d-11), [beneficiary](/usc/42/300gg–91.md?p=d-2), or enrollee) a written notice in accordance with [subsection (d)(1)(B)](#d-1-B), with respect to furnishing an item or [service](/usc/42/201.md?p=a) to such [participant](/usc/42/300gg–91.md?p=d-11), [beneficiary](/usc/42/300gg–91.md?p=d-2), or enrollee, shall retain such notice for at least a 7-year period after the date on which such item or [service](/usc/42/201.md?p=a) is so furnished.
- (f) **Definitions—** In this section:
  - (1) The terms “nonparticipating [provider](/usc/42/299b–21.md?p=8)” and “participating [provider](/usc/42/299b–21.md?p=8)” have the meanings given such terms, respectively, in subsection (a)(3) of [section 300gg–111 of this title](/usc/42/300gg–111.md).
  - (2) The term “participating health care facility” has the meaning given such term in subsection (b)(2) of [section 300gg–111 of this title](/usc/42/300gg–111.md).
  - (3) The term “nonparticipating facility” means—
    - (A) with respect to emergency [services](/usc/42/201.md?p=a) (as defined in [section 300gg–111(a)(3)(C)(i) of this title](/usc/42/300gg–111.md?p=a-3-C-i)) and a [group health plan](/usc/42/300bb–8.md?p=1) or group or [individual health insurance coverage](/usc/42/300gg–91.md?p=b-5) offered by a [health insurance issuer](/usc/42/300gg–91.md?p=b-2), an emergency department of a [hospital](/usc/42/300s–3.md?p=1), or an independent freestanding emergency department, that does not have a contractual relationship with the plan or issuer, respectively, with respect to the furnishing of such [services](/usc/42/201.md?p=a) under the plan or coverage, respectively; and
    - (B) with respect to [services](/usc/42/201.md?p=a) described in [section 300gg–111(a)(3)(C)(ii) of this title](/usc/42/300gg–111.md?p=a-3-C-ii) and a [group health plan](/usc/42/300bb–8.md?p=1) or group or [individual health insurance coverage](/usc/42/300gg–91.md?p=b-5) offered by a [health insurance issuer](/usc/42/300gg–91.md?p=b-2), a [hospital](/usc/42/300s–3.md?p=1) or an independent freestanding emergency department, that does not have a contractual relationship with the plan or issuer, respectively, with respect to the furnishing of such [services](/usc/42/201.md?p=a) under the plan or coverage, respectively.
  - (4) The term “participating facility” means—
    - (A) with respect to emergency [services](/usc/42/201.md?p=a) (as defined in clause (i) of [section 300gg–111(a)(3)(C) of this title](/usc/42/300gg–111.md?p=a-3-C)) that are not described in [clause (ii)](/usc/42/300gg–111.md?p=a-3-C-ii) of such section and a [group health plan](/usc/42/300bb–8.md?p=1) or group or [individual health insurance coverage](/usc/42/300gg–91.md?p=b-5) offered by a [health insurance issuer](/usc/42/300gg–91.md?p=b-2), an emergency department of a [hospital](/usc/42/300s–3.md?p=1), or an independent freestanding emergency department, that has a direct or indirect contractual relationship with the plan or issuer, respectively, with respect to the furnishing of such [services](/usc/42/201.md?p=a) under the plan or coverage, respectively; and
    - (B) with respect to [services](/usc/42/201.md?p=a) that pursuant to clause (ii) of [section 300gg–111(a)(3)(C) of this title](/usc/42/300gg–111.md?p=a-3-C), of [section 9816(a)(3) of title 26](/usc/26/9816.md?p=a-3), and of [section 1185e(a)(3) of title 29](/usc/29/1185e.md?p=a-3), as applicable are included as emergency [services](/usc/42/201.md?p=a) (as defined in [clause (i)](/usc/29/1185e.md) of such section and a [group health plan](/usc/42/300bb–8.md?p=1) or group or [individual health insurance coverage](/usc/42/300gg–91.md?p=b-5) offered by a [health insurance issuer](/usc/42/300gg–91.md?p=b-2), a [hospital](/usc/42/300s–3.md?p=1) or an independent freestanding emergency department, that has a contractual relationship with the plan or coverage, respectively, with respect to the furnishing of such [services](/usc/42/201.md?p=a) under the plan or coverage, respectively.

## Footnotes

[^1]: So in original. Probably should be followed by a comma.

## Source credit

(July 1, 1944, ch. 373, title XXVII, § 2799B–2, as added Pub. L. 116–260, div. BB, title I, § 104(a), Dec. 27, 2020, 134 Stat. 2824.)