US · guidance
CMS Pub. 100-01, ch. 3, § 20.4.1
Applications of Deductible and Coinsurance in Liability and
Indemnification Situations
(Rev. 12, Issued: 10-22-04, Effective: 04-01-05, Implementation: 04-04-05)
Under 1879 of the Act, a beneficiary is not responsible for payment of the Part B
deductible or coinsurance for items or services that are neither reasonable and necessary
to diagnose or treat the illness or injury, nor to improve the functioning of a malformed
body member. If the provider knew, or should have known, that Medicare considered
such services medically unnecessary, but failed to inform the beneficiary before
furnishing them, the provider is held liable for their cost. If the beneficiary made
payment for such items or services, he/she can be indemnified for them.
In most cases, however, funds can be collected while awaiting the outcome of review of a
demand bill for institutional services-- See Publication 100-04, Chapter 1, §60.3, See
§60.3.1 in the same chapter for specific information on limitations on collecting funds
from beneficiaries in SNF Part A stays. In general, see Chapter 30 of that publication for
information on limitation of liability.
History
(Rev. 12, Issued: 10-22-04, Effective: 04-01-05, Implementation: 04-04-05)
Provenance
- Source
- cms.gov
- Retrieved
- 2026-08-25
- Edition
- iom-2026-08-25
- Content hash
add03035023062775c231014424fb077d2304061e30b3cd2dbe8bea50a70a3fe
The link goes to the issuing authority’s own document — the one we read to produce this record. Where a source publishes whole titles rather than sections, your browser may need a moment to jump to the provision.
Unofficial copy of government-published law, reproduced from official sources with full provenance. Not an official publication; verify against official sources before relying on it in a filing. Records in the 'guidance' corpus, and only that corpus, are sub-regulatory (interpretive guidelines, survey procedures) and are not binding law. Validity bounds follow each jurisdiction's declared temporalBasis.