US · guidance
CMS Pub. 100-06, ch. 3, § 10.2
Individual Overpayments
An individual overpayment is an incorrect payment for provider or physician services made under title
XVIII.
Examples of individual overpayment cases are:
• Payment for provider, supplier or physician services after benefits have been exhausted, or where
the individual was not entitled to benefits.
• Incorrect application of the deductible or coinsurance.
• Payment for noncovered items and services, including medically unnecessary services or custodial
care furnished an individual.
• Payment based on a charge that exceeds the reasonable charge.
• Duplicate processing of charges/claims.
• Payment to a physician on a non-assigned claim or to a beneficiary on an assigned claim.
(Payment made to wrong payee.)
• Primary payment for items or services for which another entity is the primary payer
• Payment for items or services rendered during a period of non-entitlement.
History
(Rev. 29, 01-02-04)
Provenance
- Source
- cms.gov
- Retrieved
- 2026-08-25
- Edition
- iom-2026-08-25
- Content hash
daba8cdc837b1b0197630e1bebe211eef2113726cc56a1216aa5c68a273de25e
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.