The maximum amount that a non-participating physician is permitted to charge a Medicare beneficiary for a particularly defined procedure or bundled service. These limits are published by the individual state intermediaries for Medicare and CMS and are usually combined in reports with the allowed charges and regional payment schedules. In 1993, the limiting charge was set at 115 percent of the Medicare-allowed charge. However, this does not reflect what the physician will be paid.
Congress-enacted law which limits what a physician may charge Medicare beneficiaries for medical services; every charge on a NONASSIGNED Medicare claim for physician's services is subject to a legal limit called the limiting charge; these physician charges to a Medicare beneficiary may not exceed the maximum of 115% of the Medicare allowed amount for any service or procedure rendered.
The maximum a physician who does not accept assignment may legally charge for a Medicare-covered service.
The maximum amount a doctor may charge a Medicare beneficiary for a covered service if the doctor does not accept assignment of the Medicare claim. The limit is 15 percent above Medicare's approved amount for a particular service. Limiting charge information appears on the Explanation of Medicare Benefits (EOMB) form sent beneficiaries after they receive services covered by Part B.
In the Original Medicare Plan, the highest amount of money you can be charged for a covered service by doctors and other health care suppliers who don?t accept assignment. The limiting charge is 15% over Medicare?s approved amount. The limiting charge only applies to certain services and doesn?t apply to supplies or equipment.
An upper limit on how much doctors who do not accept Medicare's approved amount as payment in full can charge to people with Medicare. Federal law sets the limit at 15 percent more than the Medicare-approved amount. Some states limit it even further. For example, in New York it is 5 percent more. This charge is in addition to 20 percent coinsurance (50 percent for mental health services). Providers who "opt out" of Medicare are not subject to these limiting charges and can charge as much as they want, if the patient signs an agreement with them prior to receiving care.
Under Medicare, the maximum amount a nonparticipating physician is allowed to charge, currently limited to 115 percent of the Medicare-approved amount.
The maximum amount a physician may charge a Medicare beneficiary for a covered physician service if the physician does not accept assignment of the Medicare claim. The limit is 15% above the fee schedule amount for non-participating physicians. Limiting charge information appears on Medicare's Explanation of Medicare Benefits (EOMB) form.
This is the maximum amount a physician can charge a Medicare beneficiary for a covered service if the physician does not accept assignment. Patients are not required to pay more than the limiting charge for the service.
Also called Limiting Physician Charge. This refers to the OBRA 1989 and 1990 legislation which, among other things, attempts to put a cap or ceiling on the amount medical providers charge for their services under Part B of Medicare.