A non-participating (non-PAR) provider who does not accept assignment can collect a maximum of what percentage (the limiting charge) over the non-PAR Medicare fee schedule amount?

A non-participating (non-PAR) provider who does not accept assignment can collect a maximum of what percentage (the limiting charge) over the non-PAR Medicare fee schedule amount?

• A. 15%
• B. 10%
• C. 5%
• D. 25%

Answer: (A)

When a provider is nonparticipating and does not accept assignment, Medicare sets a limit on how much above the Medicare fee schedule they can bill the patient. This limit is 15% over the Medicare-approved amount, meaning the provider can charge up to 115% of the MPFS. That’s why the correct answer is 15%: it represents the maximum excess above the Medicare fee schedule allowed under the limiting charge. If the provider did accept assignment, they wouldn’t apply this limit and would bill you only the coinsurance/deductible portion of the MPFS.

When a provider is nonparticipating and does not accept assignment, Medicare sets a limit on how much above the Medicare fee schedule they can bill the patient. This limit is 15% over the Medicare-approved amount, meaning the provider can charge up to 115% of the MPFS. That’s why the correct answer is 15%: it represents the maximum excess above the Medicare fee schedule allowed under the limiting charge. If the provider did accept assignment, they wouldn’t apply this limit and would bill you only the coinsurance/deductible portion of the MPFS.