CMS Pub. 100-01, ch. 5, § 10.1.3

This section is a further explanation of §10.1.1 above.

The provider may charge the beneficiary or other person on his or her behalf: the $100

deductible and 20 percent of the customary (insofar as reasonable) charges in excess of

that deductible.

For hospital outpatient services, the allowable deductible charges depend on whether the

hospital can determine the beneficiary's deductible status. If the hospital is unable to

determine the deductible status, it may charge the beneficiary its full customary charges

up to $100. If the beneficiary provides official information as to deductible status, the

hospital may charge only the unmet portion of the deductible.

The hospital is required to indicate on the claim the amounts collected.

In the case of DME furnished as a home health service under Medicare Part B, the

coinsurance is 20 percent of the fee schedule amount for the services, with the following

exception: If the DME is used, purchased by, or on behalf of the beneficiary at a price at

least 25 percent less than the reasonable charge for comparable new equipment, no

coinsurance is required.