42 CFR § 476.85 - Conclusive effect of QIO initial denial determinations and changes as a result of DRG validations.

---
identifier: "/us/cfr/t42/s476.85"
source: "ecfr"
legal_status: "authoritative_unofficial"
title: "42 CFR § 476.85 - Conclusive effect of QIO initial denial determinations and changes as a result of DRG validations."
title_number: 42
title_name: "Public Health"
section_number: "476.85"
section_name: "Conclusive effect of QIO initial denial determinations and changes as a result of DRG validations."
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"
---


# 476.85 Conclusive effect of QIO initial denial determinations and changes as a result of DRG validations.

A QIO initial denial determination or change as a result of DRG validation is final and binding unless, in accordance with the procedures in part 473—

(a) The initial denial determination is reconsidered and revised; or

(b) The change as a result of DRG validation is reviewed and revised.