CMS Pub. 100-04, ch. 23, § 80.3.2

B3-5010.3

A/B MACs (B)/DME MACs establish and maintain adequate data on the customary

charges for specific services and procedures made by individual physicians and other

persons and organizations which render covered services. This data must be readily

available. The customary charge record for each entity rendering covered services must

include a minimum of the following data:

• Entity name, address, identification code, locality and specialty status;

• A continuing history of the entity’s charges for specific services, supplies, etc;

• A customary charge for each specific service or item derived from the entity’s

history of charges for that service or item (and which is to be used as the basis for

the determination of reasonable charges in conjunction with the prevailing charge

criterion); and

• For a charge made under unusual circumstances, include a description of the

circumstances.

A/B MACs (B)/DME MACs develop and include in the entity’s profile a customary charge

conversion factor for use with a relative value scale when there is insufficient data to

establish the actual customary charge or when an infrequently performed service or item is

involved.