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CMS Pub. 100-04, ch. 1, § 30.1.1

Provider Charges to Beneficiaries

activein force · 2026-08-25 – presentas-observed

In the agreement/attestation statement signed by a provider, it agrees not to charge

Medicare beneficiaries (or any other person acting on a beneficiary’s behalf) for any

service for which Medicare beneficiaries are entitled to have payment made on their

behalf by the Medicare program. This includes items or services for which the

beneficiary would have been entitled to have payment made had the provider filed a

request for payment (see §50).

The provider may bill the beneficiary for the following items:

• Part A deductible;

• Part B deductible;

• First 3 pints of blood, which is called the blood deductible (if there is a charge for

blood or the blood is not replaced);

• Part B coinsurance;

• Part A coinsurance; or

• Services that are not Medicare covered services. See Chapter 30 for related

requirements.

SNFs may not require, request, or accept a deposit or other payment from a Medicare

beneficiary as a condition for admission, continued care, or other provision of services,

except as follows:

• A SNF may request and accept payment for a Part A deductible and coinsurance

amount on or after the day to which it applies.

• A SNF may request and accept payment for a Part B deductible and coinsurance

amount at the time of or after the provision of the service to which it applies.

• A SNF may not request or accept advance payment of Medicare deductible and

coinsurance amounts.

• A SNF may require, request, or accept a deposit or other payment for services if it

is clear that the services are not covered by Medicare and proper notice is

provided. See Chapter 30 for instructions about ABNs and demand bills.

• SNFs, but not hospitals, may bill the beneficiary for holding a bed during a leave

of absence if the requirements in §30.1.1.1 are met.

History

(Rev. 2921, Issued: 04-04-14, Effective: 05-05-14, Implementation: 05-05-14)

Provenance

Source
cms.gov
Retrieved
2026-08-25
Edition
iom-2026-08-25
Content hash
b0532e18b2f344c239e3685ae0b33113d7053ee2d27cbfa2296c8d766611904b
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