OT: participating amt vs. non participating amt vs. limiting charge amt

Thread view:

Enable EMail Alerts

Start New Thread

Thread rating:

sill - 14 Dec 2004 23:29 GMT

Hi i had a comprehensive eye exam by an ophthalmologist and got the
invoice from medicare. i looked at the procedure code that was billed
and was curious about it so i went to the medicare website to look it
up. now for 92004 there were 3 different fees. why is that? is
limiting charge amount the highest my doctor can put on the insurance
claim, or does he just file the highest fee for participating amt?
just wondering......

sill

Reply to this Message

nipidoc - 15 Dec 2004 02:58 GMT

I'm not sure why there are 3 different fees for the same code. Can you post
a link to that??

Your doctor can charge whatever he wants. If he wants to charge a million
dollars, he can.

But the medicare will only pay him the limiting charge amount (less any
deductables or copays)

So if the limiting charge amount is $85.00 he will get $85.00 whether he
submits a bill for $100 or for $100000000.

> Hi i had a comprehensive eye exam by an ophthalmologist and got the
> invoice from medicare. i looked at the procedure code that was billed
[quoted text clipped - 5 lines]
>
> sill

Reply to this Message