[Code of Federal Regulations]

[Title 42, Volume 4]

[Revised as of October 1, 2006]

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

[CITE: 42CFR489.32]



[Page 959]

 

                         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.  489.32  Allowable charges: Noncovered and partially covered 



services.



    (a) Services requested by beneficiary. If services furnished at the 

request of a beneficiary (or his or her representative) are more 

expensive than, or in excess of, services covered under Medicare--

    (1) A provider may charge the beneficiary an amount that does not 

exceed the difference between--

    (i) The provider's customary charges for the services furnished; and

    (ii) The provider's customary charges for the kinds and amounts of 

services that are covered under Medicare.

    (2) A provider may not charge for the services unless they have been 

requested by the beneficiary (or his or her representative) nor require 

a beneficiary to request services as a condition of admission.

    (3) To avoid misunderstanding and disputes, a provider must inform 

any beneficiary who requests a service for which a charge will be made 

that there will be a specified charge for that service.

    (b) Services not requested by the beneficiary. For special 

provisions that apply when a provider customarily furnishes more 

expensive services, see Sec.  413.35 of this chapter.



[45 FR 22937, Apr. 4, 1980, as amended at 51 FR 34833, Sept. 30, 1986]