42 CFR § 476.83 - Initial denial determinations.

---
identifier: "/us/cfr/t42/s476.83"
source: "ecfr"
legal_status: "authoritative_unofficial"
title: "42 CFR § 476.83 - Initial denial determinations."
title_number: 42
title_name: "Public Health"
section_number: "476.83"
section_name: "Initial denial determinations."
chapter_name: "CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES"
subchapter_number: "F"
subchapter_name: "QUALITY IMPROVEMENT ORGANIZATIONS"
part_number: "476"
part_name: "QUALITY IMPROVEMENT ORGANIZATION REVIEW"
positive_law: false
currency: "2026-04-05"
last_updated: "2026-04-05"
format_version: "1.1.0"
generator: "[email protected]"
authority: "42 U.S.C. 1302 and 1395hh."
regulatory_source: "44 FR 32081, June 4, 1979, unless otherwise noted. Redesignated at 64 FR 66279, Nov. 24, 1999."
cfr_part: "476"
---


# 476.83 Initial denial determinations.

A determination by a QIO that the health care services furnished or proposed to be furnished to a patient are not medically necessary, are not reasonable, or are not at the appropriate level of care, is an initial denial determination and is appealable under part 473 of this chapter.