US · guidance
CMS Pub. 100-01, ch. 3, § 20.3
Part B Coinsurance
After the deductible has been satisfied, coinsurance of 20 percent is usually applicable.
For providers and suppliers that bill A/B MAC(A) or (HHH), the 20 percent may be
based on the allowed amount, billed charges, or a preset rate per service (APC),
depending upon the type of service. See Claims Processing instructions for a description
of coinsurance calculation for each benefit type.
Physicians and other suppliers will be paid 80 percent of allowed amount under the fee
schedule amounts or in some instances reasonable charges incurred during the balance of
the calendar year. The patient is responsible for a coinsurance amount equal to 20
percent of the fee schedule amounts or reasonable charges for the items and services.
(See §20.4 of this chapter for exceptions.)
History
(Rev. 1, 09-11-02)
Provenance
- Source
- cms.gov
- Retrieved
- 2026-08-25
- Edition
- iom-2026-08-25
- Content hash
105e6c07a3550daceb6bd2374d066b223da04e57b446bd7939e2ec05ad43f1b6
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