Law and Advocacy Division

On October 1, 1994 the law allowing physicians to charge specific sums for preparation and production of medical records went into effect. This law is codified in the Health-General Article § 4-304(c)(3). The law also states that these fees may be adjusted annually for inflation using the Consumer Price Index on July 1 of each year. The statute does not designate an entity to compute the increases. Since 1995 MedChi has calculated and published the appropriate adjustment, not in any official capacity, but as a service to its members and the Maryland public.

The adjusted rates for medical record copying are as follows:

Physicians may demand payment of these fees and charges before turning the records over to a patient or other authorized person (such as the patient's parent, guardian or lawyer), but probably not before complying with a proper subpoena. Production may not be withheld under an emergency request from a state or local governmental unit concerning a child protective services or adult protective services case pending payment. MedChi's Professional Ethics Committee has opined that records should not be withheld from another health practitioner pending payment of the copying fees if to do so would hinder an ill patient from receiving needed medical attention. No fee may be charged to transfer the records of Medicaid recipient to another provider. Finally, the law does not authorize any practitioner to withhold production of the medical records until the fees for medical services themselves have been paid.

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The Privacy Rule states that providers "may charge a reasonable, cost-based fee, provided that the fee includes only the cost of copying, including the cost of supplies for and labor of copying, the protected health information requested by the individual and postage, when the individual has requested the copy, or the summary of explanation, be mailed." 45 CFR 164.524(c)(4). The December 2000 commentary to the Rule stated that "fees for copying and postage provided under state law, but not for other costs excluded under this Rule, are presumed reasonable." Federal Register, Vol.65, No.250, Thursday, December 28, 2000, at 82557. The comments encourage providers to "limit the fee for copying so that it is within reach of all individuals."

This restriction applies only to copies provided to patients.

Therefore, physicians and other health care providers may still charge the Maryland statutory fee (currently, 69 cents per page copied) but not the preparation fee (currently $21.00). These fees may still be charged to individuals other than the patient (or the patient’s "personal representative" as provided under the Rule).

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