A limiting charge is the highest amount that a healthcare provider who does not accept assignment from Medicare can charge a patient for a covered service. Medicare sets this limit at 15% above the Medicare-approved amount for the service. If a provider charges more than the limiting charge, the patient may be responsible for paying the excess amount out of pocket. Limiting charges apply to services covered under Medicare Part B, such as doctor visits, outpatient procedures, and durable medical equipment. Patients can minimize their out-of-pocket costs by seeking care from participating providers who accept assignment and agree to accept Medicare’s approved amount as payment in full.
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