Last Modified: 5/7/2016 Location: FL, PR, USVI Business: Part A, Part B
Fee schedule par and non-par explanation FAQ
Q. I’ve been using the “First Coast Service Options fee schedule look-up” for Part B -- what do par fee, nonpar fee, and limiting charge mean?
A. Amounts listed under “par fee” represent the potential Medicare allowance for a physician or nonphysician practitioner who has signed a Medicare participation agreement (form CMS-460). (Click here for more information about the CMS-460.) Signing this agreement means the provider has agreed to accept Medicare allowances as payment in full; the benefits are therefore assigned to the provider.
Amounts listed under “nonpar fee” represent the potential Medicare allowance for a physician or nonphysician practitioner who has NOT signed a participation agreement; these allowances are generally 95 percent of the amount for a participating provider in the same area. Nonparticipating providers may choose to accept Medicare assignment or not.
The limiting charge is the maximum amount a nonparticipating provider may legally charge a beneficiary when filing an unassigned claim. The limiting charge for a service is 115 percent of the nonpar amount.
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