42 CFR § 456.122 - Evaluation criteria for admission review.

---
identifier: "/us/cfr/t42/s456.122"
source: "ecfr"
legal_status: "authoritative_unofficial"
title: "42 CFR § 456.122 - Evaluation criteria for admission review."
title_number: 42
title_name: "Public Health"
section_number: "456.122"
section_name: "Evaluation criteria for admission review."
chapter_name: "CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES"
subchapter_number: "C"
subchapter_name: "MEDICAL ASSISTANCE PROGRAMS"
part_number: "456"
part_name: "UTILIZATION CONTROL"
positive_law: false
currency: "2026-03-24"
last_updated: "2026-03-24"
format_version: "1.1.0"
generator: "[email protected]"
authority: "42 U.S.C. 1302."
regulatory_source: "43 FR 45266, Sept. 29, 1978, unless otherwise noted."
cfr_part: "456"
---


# 456.122 Evaluation criteria for admission review.

The UR plan must provide that—

(a) The committee develops written medical care criteria to assess the need for admission; and

(b) The committee develops more extensive written criteria for cases that its experience shows are—

(1) Associated with high costs;

(2) Associated with the frequent furnishing of excessive services; or

(3) Attended by physicians whose patterns of care are frequently found to be questionable.