Explanation of Limiting Charges

Medicare has a limiting charge, the largest fee that a non-participating health care professional or supplier can charge a patient.

This limiting charge applies to the following services, regardless of who provides them or bills for them:

• Diagnostic tests
• Outpatient physical therapy furnished by an independent practicing physical therapist
• Outpatient occupational therapy furnished by an independent practicing occupational therapist
• Physicians’ services
• Radiation therapy services, including x-ray, radium, and radioactive isotope therapy, and materials and services of technicians
• Services and supplies furnished incident to a physician’s service that are commonly furnished in a physician’s office

Note: The limiting charge doesn’t apply to DMEPOS claims.