Q. How much may we charge patients for copying medical records?
A. Texas Medical Board (TMB) rules (including §165.2. Medical Record Release and Charges) set the maximum allowable charge for copies under Texas law. TMB recently updated the rules to address electronic copies. The board says physicians may charge a "reasonable, cost-based fee," as follows:
- For paper copies, you may charge no more than $25 for the first 20 pages, and 50 cents for each page thereafter. Thus, you may charge a maximum of $27.50 for a 25-page paper chart.
- For records provided in an electronic format, you may charge no more than $25 for 500 pages or less and $50 for more than 500 pages.
- If your practice provides the records in a hybrid — partially electronic and partially paper — format, the board says a reasonable fee would be a combination of the above fees.
The rules also allow you to charge a reasonable fee for the actual costs of labor, supplies, and postage. You may not charge a separate retrieval or "pull fee."
- The rules set a maximum of $8 per copy for films or other diagnostic imaging studies.
- If an affidavit is requested certifying that the information is a true and correct copy of the records, you may charge a reasonable fee of up to $15 for executing the affidavit.
These are maximums, and the rules bear out that the fee you actually charge must be "cost based." Thus, merely following the guideline may not be sufficient to meet the regulation's mandate.
Generally, physicians may retain the records until receiving payment of a copy fee (though there are some exceptions). However, you may not withhold records from the patient, if the patient has paid the copy fee, because he or she has a past due account.
The TMB rules apply to physicians who charge copying fees for medical records in most situations. For information about charging fees in other situations, see TMA's white paper on the TMA Medical Records resource page.
Have more questions about medical records? TMA's publication, Managing Your Medical Records addresses consent, release, privacy, and more under Texas law and HIPAA.
Also, as always, check the Texas Medical Board website for updates on its rules and policies regarding medical records.
Revised March 25, 2014
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