42 CFR § 478.10 - Scope.

---
identifier: "/us/cfr/t42/s478.10"
source: "ecfr"
legal_status: "authoritative_unofficial"
title: "42 CFR § 478.10 - Scope."
title_number: 42
title_name: "Public Health"
section_number: "478.10"
section_name: "Scope."
chapter_name: "CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES"
subchapter_number: "F"
subchapter_name: "QUALITY IMPROVEMENT ORGANIZATIONS"
part_number: "478"
part_name: "RECONSIDERATIONS AND APPEALS"
positive_law: false
currency: "2026-04-05"
last_updated: "2026-04-05"
format_version: "1.1.0"
generator: "[email protected]"
authority: "Secs. 1102 and 1871 of the Social Security Act (42 U.S.C. 1302 and 1395hh)."
cfr_part: "478"
---


# 478.10 Scope.

This subpart establishes the requirements and procedures for—

(a) Reconsiderations conducted by a Utilization and Quality Control Quality Improvement Organization (QIO) or its subcontractor of initial denial determinations concerning services furnished or proposed to be furnished under Medicare;

(b) Hearings and judicial review of reconsidered determinations; and

(c) QIO review of a change in diagnostic and procedural coding information.

[50 FR 15372, Apr. 17, 1985; 50 FR 41887, Oct. 16, 1985. Redesignated at 64 FR 66279, Nov. 24, 1999]