US · guidance
CMS Pub. 100-04, ch. 23, § 80.2
Updating Customary and Prevailing Charges
B3-5003
A/B MACs (B)/DME MACs update customary and prevailing charge limits at the
beginning of each fee screen year (the 12-month period beginning January), using available
statistics on charges for services from claims processed or services rendered during the 12-month period ending June 30 immediately preceding the start of the fee screen year. For
example, the limits used during fee screen year 2003 (January 1, 2003, through December
31, 2003) were based on the charges made from July 1, 2001, through June 30, 2002.
Customary and prevailing charge screens for a fee screen year are not changed except for
the following reasons:
• In individually identified and highly unusual situations where equity clearly
indicates that the increases are warranted and requested by the entity furnishing the
service;
• To correct erroneous calculations; or
• To establish screens for new services.
A/B MACs (B)/DME MACs must ensure that all data on the frequency of services, all data
files and customary and prevailing charge files used to establish reasonable charge screens
are retained and are available for use.
History
(Rev. 1, 10-01-03)
Provenance
- Source
- cms.gov
- Retrieved
- 2026-08-25
- Edition
- iom-2026-08-25
- Content hash
ed7c12e18e7f181bbced39af1c84fa5cc9b1208d5373503def762f4c2398e62a
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