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Charges for Medicare patients vs Commercial Carriers

  1. Default Charges for Medicare patients vs Commercial Carriers
    Medical Coding Books
    I am trying to locate Medicare's regulation regarding charges. It has always been my understanding that a physician and/or facility must be consistent with their charges. By this I mean, you are not permitted to charge a Medicare recipient differently than a Commercial Insurance recipient or a self pay; the fee schedule should be the same across the board.

    Example: code 99241 Medicare is being billed $175.00
    code 99241 Aetna is being billed $150.00
    code 99241 Self-pay is being billed $150.00

    I certainly understand the reimbursement will be different and that we can charge any amount we want, but that gross charge should be the same for everyone.

    Any help finding this regulation is much appreciated.

    R Kennedy, CPC

  2. #2
    I would be interested in hearing the rationale from anyone who feels ALL charges should not the same across payers. I have seen this handled different ways, but it seems that the only logical position is to have a consistent set of fees, and understand that different payers will reimburse different amounts.

    Unfortunately, what makes sense isn't always what is/should be done, so I am very interested in hearing different opinions on this.

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