US · guidance
CMS Pub. 100-04, ch. 30, § 50.15.1
Physicians’ Services RR
The physicians’ services RR provision, found in §1842(l) of the Act as amended by the
Omnibus Budget Reconciliation Act (OBRA) of 1986, requires timely refunds for certain
services. When a reduction in payment, not a full denial, occurs, the physician must
refund to the beneficiary amounts collected which exceed the Medicare payment for the
less extensive item or service. These RR apply to both participating and non-participating physicians.
When the beneficiary signs an ABN agreeing to accept responsibility for payment before
services are delivered, the collected funds can be retained. A refund is not required if the
physician did not know and could not reasonably have been expected to know that
Medicare would not pay for the services because they were not reasonable and necessary.
The Medicare contractor must notify the beneficiary in any case in which the physician
requests review of the denial or reduction in payment or asserts that a refund is not
required.
History
(Rev. 10862; Issued: 07-14-21; Effective: 10-14-21; Implementation: 10-14-21)
Provenance
- Source
- cms.gov
- Retrieved
- 2026-08-25
- Edition
- iom-2026-08-25
- Content hash
b8d787be2cb3dedf82725ff40bd280163acf9b6f2536d25cba504e142037c5fa
The link goes to the issuing authority’s own document — the one we read to produce this record. Where a source publishes whole titles rather than sections, your browser may need a moment to jump to the provision.
Unofficial copy of government-published law, reproduced from official sources with full provenance. Not an official publication; verify against official sources before relying on it in a filing. Records in the 'guidance' corpus, and only that corpus, are sub-regulatory (interpretive guidelines, survey procedures) and are not binding law. Validity bounds follow each jurisdiction's declared temporalBasis.