[Code of Federal Regulations]

[Title 42, Volume 3]

[Revised as of October 1, 2005]

From the U.S. Government Printing Office via GPO Access

[CITE: 42CFR489.30]



[Page 950-951]

 

                         TITLE 42--PUBLIC HEALTH

 

  CHAPTER IV--CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF 

                  HEALTH AND HUMAN SERVICES (CONTINUED)

 

PART 489_PROVIDER AGREEMENTS AND SUPPLIER APPROVAL--Table of Contents

 

                       Subpart C_Allowable Charges

 

Sec. 489.30  Allowable charges: Deductibles and coinsurance.





    (a) Part A deductible and coinsurance. The provider may charge the 

beneficiary or other person on his or her behalf:

    (1) The amount of the inpatient hospital deductible or, if less, the 

actual charges for the services;

    (2) The amount of inpatient hospital coinsurance applicable for each 

day the individual is furnished inpatient hospital services after the 

60th day, during a benefit period; and

    (3) The posthospital SNF care coinsurance amount.

    (4) In the case of durable medical equipment (DME) furnished as a 

home health service, 20 percent of the customary charge for the service.

    (b) Part B deductible and coinsurance. (1) The basic allowable 

charges are the $75 deductible and 20 percent of the customary (insofar 

as reasonable) charges in excess of that deductible.

    (2) For hospital outpatient services, the allowable deductible 

charges depend on whether the hospital can determine the beneficiary's 

deductible status.

    (i) If the hospital is unable to determine the deductible status, it 

may



[[Page 951]]



charge the beneficiary its full customary charges up to $75.

    (ii) If the beneficiary provides official information as to 

deductible status, the hospital may charge only the unmet portion of the 

deductible.

    (3) In either of the cases discussed in paragraph (b)(2) of this 

section, the hospital is required to file with the intermediary, on a 

form prescribed by CMS, information as to the services, charges, and 

amounts collected.

    (4) The intermediary must reimburse the beneficiary if reimbursement 

is authorized and credit the expenses to the beneficiary's deductible if 

the deductible has not yet been met.

    (5) In the case of DME furnished as a home health service under 

Medicare Part B, the coinsurance is 20 percent of the customary (insofar 

as reasonable) charge for the services, with the following exception: If 

the DME is used DME purchased by or on behalf of the beneficiary at a 

price at least 25 percent less than the reasonable charge for comparable 

new equipment, no coinsurance is required.



[45 FR 22937, Apr. 4, 1980, as amended at 51 FR 41350, Nov. 14, 1986]