C.F.R. » Title 42 » CHAPTER IV—CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES › SUBCHAPTER B—MEDICARE PROGRAM › PART 414—PAYMENT FOR PART B MEDICAL AND OTHER HEALTH SERVICES › Subpart B—Physicians and Other Practitioners

42 C.F.R. § 414.21

Medicare payment basis

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Medicare payment is based on the lesser of the actual charge or the applicable fee schedule amount.

[62 FR 59101, Oct. 31, 1997]
Notes of Decisions
Cited in 1 case, 1999–1999 · leading case: Ex Rel. Gublo v. NovaCare, Inc., 62 F. Supp. 2d 347 (D. Mass. 1999).
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Ex Rel. Gublo v. NovaCare, Inc., 62 F. Supp. 2d 347 (D. Mass. 1999). “Pursuant to 42 C.F.R. § 414.21 , Medicare pays for prosthetics and orthotics at 80% of the lesser of (1) the actual charge for the device; or (2) the fee schedule amount for the device.”
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