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42 U.S. Code § 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), in the case of a participant, beneficiary, or enrollee with benefits under a group health plan or group or individual health insurance coverage offered by a health insurance issuer and who is furnished during a plan year beginning on or after January 1, 2022, items or services (other than emergency services to which section 300gg–131 of this title applies) for which benefits are provided under the plan or coverage at a participating health care facility by a nonparticipating provider, such provider shall not bill, and shall not hold liable, such participant, beneficiary, or enrollee for a payment amount for such an item or service furnished by such provider with respect to a visit at such facility that is more than the cost-sharing requirement for such item or service (as determined in accordance with subparagraphs (A) and (B) of section 300gg–111(b)(1) of this title [1] of section 9816(b)(1) of title 26, and of section 1185e(b)(1) of title 29, as applicable).
(b) Exception
(1) In general
Subsection (a) shall not apply with respect to items or services (other than ancillary services described in paragraph (2)) furnished by a nonparticipating provider to a participant, beneficiary, or enrollee of a group health plan or group or individual health insurance coverage offered by a health insurance issuer, if the provider satisfies the notice and consent criteria of subsection (d).
(2) Ancillary services describedFor purposes of paragraph (1), ancillary services described in this paragraph are, with respect to a participating health care facility—
(A)
subject to paragraph (3), items and services related to emergency medicine, anesthesiology, pathology, radiology, and neonatology, whether or not provided by a physician or non-physician practitioner, and items and services provided by assistant surgeons, hospitalists, and intensivists;
(B)
subject to paragraph (3), diagnostic services (including radiology and laboratory services);
(C)
items and services provided by such other specialty practitioners, as the Secretary specifies through rulemaking; and
(D)
items and services provided by a nonparticipating provider if there is no participating provider who can furnish such item or service at such facility.