decisionhealth Newsletters, Answer Books - 2008 Issue 5 (May)
Medicare_Carriers_Manual / 17002 / 17002
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Article Overview
This article covers a Medicare manual policy section on the limiting charge, including how the rule changed across service dates and how it relates to non-participating physicians and certain covered services. It also includes a Medicare participating physician or supplier agreement exhibit and related administrative information. The content is relevant to Medicare billing professionals, physician practices, suppliers, and compliance staff who need to understand the scope of the policy and the associated agreement form.
Why This Topic Matters
Understanding this manual section helps readers recognize the policy framework governing limiting charge issues and the related Medicare participation agreement. It is useful for organizations that manage Medicare Part B claims, enrollment, and compliance under older and transitional payment rules.
Article Sections
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Ed. Note: For further information see
A brief editorial note pointing to related claims-filing material in another Medicare manual chapter.
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17002. LIMITING CHARGE
The main policy section describing the limiting charge framework, including how it changed over time and how it relates to Medicare-covered services and non-participating physician billing.
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EXAMPLE 1: (Non-E&M Service)
An illustrative example showing how the policy is applied in a non-evaluation and management scenario.
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EXAMPLE 2: (E&M Service)
An illustrative example showing how the policy is applied in an evaluation and management scenario.
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EXAMPLE 3
An illustrative example showing how the policy is applied in a later year transition scenario.
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EXAMPLE 4
An illustrative example showing the policy for a subsequent fee schedule year.
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EXHIBIT 1 MEDICARE PARTICIPATING PHYSICIAN OR SUPPLIER AGREEMENT
The text of a Medicare participation agreement form, including agreement terms, administrative fields, and standard paperwork reduction information.
What You Will Learn
- How the article frames the limiting charge policy across different time periods
- What general categories of services are addressed by the policy section
- How the article connects limiting charge policy to Medicare participation and assignment
- What types of administrative and form-related information are included in the exhibit
Who Should Read This
- Medical coders
- Billing staff
- Physician practice administrators
- Compliance professionals
- Medicare enrollment personnel
- Healthcare reimbursement specialists
Code Ranges Discussed
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