Definitions for "Reasonable and Customary"
The amount customarily charged for the service by other physicians in the area (often defined as a specific percentile of all charges in the community), and the reasonable cost of services for a given patient after medical review of the case. Also called "Usual, Customary and Reasonable" (UCR).
Billing charges that insurers believe are appropriate for services throughout a region or community.
The amount that a plan considers to be the appropriate charge for a given procedure. A doctor may charge more or less than the reasonable and customary charge, but a plan will not reimburse you for charges above the reasonable and customary amount.