A procedure on the Medicare nonparticipating fee schedule is priced at $320. How much can the nonparticipating provider charge for the procedure under the Medicare limiting charge?

Question

Quizplus · Accepted Answer

The Medicare limiting charge for nonparticipating providers is 115% of the Medicare nonparticipating fee schedule amount. Therefore, for a procedure priced at $320, the provider can charge 115% of $320, which equals $368.

A Procedure on the Medicare Nonparticipating Fee Schedule Is Priced