What is the Limiting Charge in Medicare?

The Limiting Charge refers specifically to the maximum amount that a physician is allowed to charge for services provided to patients enrolled in Medicare when they do not accept assignment of the Medicare claim. When a physician accepts assignment, they agree to accept the Medicare-approved amount as full payment for services. However, if they choose not to accept assignment, they can charge the patient more, but only up to the Limiting Charge set by Medicare regulations.

This Limiting Charge is designed to protect beneficiaries from excessive costs while allowing some flexibility for healthcare providers to receive higher payments in cases where they don’t accept assigned Medicare amounts. It is important to note that even though a provider can charge above the Medicare-approved amount, there are strict guidelines regarding how much more they can add to that fee, which is what the Limiting Charge establishes.

The other options do not accurately represent the concept of the Limiting Charge. The minimum amount a physician can charge is not relevant, as there is no set minimum charge established by Medicare. Accessing benefits does not relate to how much a physician can charge, and there is no standard fee for all services; fees vary by service and are subject to the individual agreements between providers and Medicare.