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PAP700

FEP® Medicare Limiting Charge


Provider Administrative Policy

Section
FEP
Policy Date
December 2003
Status/Date
Reviewed/July 2012
Provider Type(s)
Physician  

Disclaimer

Our provider administrative policies contain information regarding claims submission, reimbursement, and other information in order to achieve an efficient relationship with our providers. These policies are not an authorization or explanation of benefits. Blue Cross of Idaho retains the right to add to, delete from and otherwise modify this policy in accordance with our provider contracts.

Policy

FEP® Medicare Limiting Charge

The Federal Employee Program (FEP)® limits Medicare reimbursement amounts for providers who do not accept Medicare assignment. If Medicare Part B is the primary payer and you do not accept Medicare assignment, FEP® will reimburse for the service, but only up to the Medicare limiting charge (115 percent of the approved Medicare payment amount).

For all services subject to the Medicare limiting charge, payment will be limited to the difference between the Medicare paid amount and the lesser of:

  • The Medicare limiting charge
  • Blue Cross of Idaho’s maximum allowance, only if no Medicare limiting charge has been established for the procedure
  • The billed charge

All providers, physicians and suppliers must accept assignment on all clinical laboratory work. Payment will be based upon the Medicare allowed amount.


Policy History

Date Action Reason
July 2012 Revised Updated FEP with registration mark.

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