US · guidance
CMS Pub. 100-04, ch. 36, § 40
Payment Rules
A single payment amount is established for each competitive bid item for each CBA based on the
bids submitted and accepted for that item. All payment for competitive bidding items is made on
an assignment related basis. The payment basis for an item is 80 percent of the applicable single
payment amount for the CBA in which the beneficiary maintains a permanent residence, less any
unmet Part B deductible described in §1833(b) of the Act. If an item that is included in a
competitive bidding program is furnished to a beneficiary who does not maintain a permanent
residence in a CBA, the payment basis for the item is 80 percent of the lesser of the actual charge
of the item, or the applicable fee schedule amount for the item. The single payment amount
calculated for each item under each competitive bidding program is paid for the duration of the
competitive bidding program and will not be adjusted by any update factor.
Payment for items or services furnished by a supplier under the Medicare Secondary Payer rules
will be calculated in accordance with the established related payment rules.
History
(Rev. 1502; Issued: 05-09-08; Effective/Implementation Date: 06-09-08)
Provenance
- Source
- cms.gov
- Retrieved
- 2026-08-25
- Edition
- iom-2026-08-25
- Content hash
7ea4b91e7f766cfc69340f0e13873eb7560eb0f874662ce40847d2d0249c26f5
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