US · guidance
CMS Pub. 100-04, ch. 1, § 150.1
Limitation on Liability - Overview
A3-3674.1
HO-414.6
Chapter 30, of this manual has a complete explanation of the limitation of liability
provision. However, the basic premise of the limitation on liability provision (§1879 of
the Act) is that beneficiaries and providers who “did not know, and could not reasonably
have been expected to know, that payment would not be made for such items(s) or
service(s) item(s) and/or service(s)” are protected from liability. Where the provider had
such knowledge, such that the 1879 limitations on liability do not apply, liability falls
upon the provider (i.e., the provider cannot charge the beneficiary for such services when
aware no program payment will be made).
Medicare requires providers to notify beneficiaries when they face financial liability, so
they can make informed choices.
History
(Rev. 632, Issued: 07-29-05, Effective: 01-03-06, Implementation: 01-03-06)
Provenance
- Source
- cms.gov
- Retrieved
- 2026-08-25
- Edition
- iom-2026-08-25
- Content hash
92b6844703953a43b2d44e8aabd457e27c277156680a8c3ab8b7ee8a5e29f0f4
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