Federal
Allowable charges: Noncovered and partially covered services.
42 CFR § 489.32
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42 CFR § 489.32
42 CFR § 489.32
Allowable charges: Noncovered and partially covered services.
(a)
Services requested by beneficiary. If services furnished at the request of a beneficiary (or his or her representative) are more expensive than, or in excess of, services covered under Medicare—
(1)
A provider may charge the beneficiary an amount that does not exceed the difference between—
(i)
The provider's customary charges for the services furnished; and
(ii)
The provider's customary charges for the kinds and amounts of services that are covered under Medicare.
(2)
A provider may not charge for the services unless they have been requested by the beneficiary (or his or her representative) nor require a beneficiary to request services as a condition of admission.
(3)
To avoid misunderstanding and disputes, a provider must inform any beneficiary who requests a service for which a charge will be made that there will be a specified charge for that service.
(b)
Services not requested by the beneficiary. For special provisions that apply when a provider customarily furnishes more expensive services, see § 413.35 of this chapter.
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