What is a limiting charge in healthcare services?

A limiting charge is defined as the maximum fee that a healthcare provider can charge a patient for a service when that provider is a non-participating provider under Medicare. This limit ensures that patients are not subjected to exorbitant fees when they receive services from doctors or suppliers who do not accept Medicare assignment. If a provider chooses not to accept the Medicare-approved amount as payment in full, they may still bill the patient up to the limiting charge, which is set as a percentage over the Medicare payment rate.

This practice is particularly important because it provides a safeguard for patients, helping to ensure that even if they choose to see a non-participating provider, they will still have some level of protection against unexpectedly high costs. Knowing the limiting charge helps both patients and providers navigate the financial aspects of care effectively. Therefore, recognizing that this charge establishes a cap on what can be billed to patients is fundamental to understanding Medicare’s framework for outpatient services.