Definitions for "Limiting charge"
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.