MEDICARE FEE SCHEDULE & limiting charges

Fee Schedules with the Participating Allowed Amounts, Non participating Allowed Amounts and Limiting Charges are issued annually (usually during the open enrollment period allowing for a change of participation status). The physician fee schedules along with ambulance, clinical lab, clinical psychologist, drug and licensed clinical social worker allowances can be found on our website at the following link or by contacting Customer Service.

Like the above link you can get it from your state Medicare website.

What is Limiting Charge 

The Limiting Charge for any service(s) billed to Medicare by non-participating physicians and non physician practitioners subject to the Limiting Charge is 115% of the non-participating fee schedule amount for that/those service(s). Compliance with Limiting Charge restrictions is monitored by NHIC.
When noncompliance is found, notification is sent on the Medicare Remittance Notice. This notification will contain instructions to refund the beneficiary any amounts found in excess of the Limiting Charge. Waivers designed to circumvent Limiting Charge regulations are invalid. Providers should refer to the Medicare Fee Schedule to determine the Limiting Charge information for a particular code or service.

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