US · guidance
CMS Pub. 100-01, ch. 5, § 10.1.5
Services Requested by Beneficiary
This section is a further explanation of §10.1.1.
If services furnished at the request of a beneficiary (or his or her representative) are more
expensive than, or in excess of, services covered under Medicare, a provider may charge
the beneficiary an amount that does not exceed the difference between (1) the provider's
customary charges for the services furnished; and (2) the provider's customary charges
for the kinds and amounts of services that are covered under Medicare.
A provider may not charge for these services unless they have been requested by the
beneficiary (or his or her representative) and may not require a beneficiary to request
services as a condition of admission.
To avoid misunderstanding and disputes, a provider must inform any beneficiary who
requests a service for which a charge will be made that there will be a specified charge
for that service.
History
(Rev. 1, 09-11-02)
Provenance
- Source
- cms.gov
- Retrieved
- 2026-08-25
- Edition
- iom-2026-08-25
- Content hash
800f1c52020dd3156a4f1369bb9164eb2442a4cd8385457935a49013fb840347
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