US · guidance
CMS Pub. 100-16, ch. mc86c16a, § 50.2
Model Terms and Conditions of Payment
CMS annually issues a model terms and conditions of payment for PFFS plans for each
contract year. CMS expects all full, partial, and non-network PFFS plans, including
employer/union sponsored PFFS plans, to implement the model terms and conditions of
payment for their deemed providers effective January 1 of the applicable contract year.
Employer/union sponsored PFFS plans that operate on a non-calendar year schedule are
expected to implement the model terms and conditions of payment effective the
beginning of the plan’s applicable contract year.
The model terms and conditions of payment provide a uniform format and content, which
is of particular benefit to providers treating members of different PFFS plans. Use of the
model also expedites review by CMS Regional Offices (ROs). Refer to section 50.3 of
this chapter for more information. The model terms and conditions of payment are
posted on the CMS website at http://www.cms.hhs.gov/PrivateFeeforServicePlans/.
History
(Rev. 99, Issued: 05-27-11, Effective: 05-27-11, Implementation: 05-27-11)
Provenance
- Source
- cms.gov
- Retrieved
- 2026-08-25
- Edition
- iom-2026-08-25
- Content hash
acf355b4104c072167a2c4e0c299da0e4a2de136035308fc203c22b700a252e0
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