US · guidance
CMS Pub. 100-16, ch. mc86c18b, § 40.2
Payment for Services Rendered On or After April 1, 1994, by
Noncontracted, Nonparticipating Physicians
(Rev. 30, 09-05-03)
If a noncontracted physician provides a service to one of the HCPP's enrollees and the
physician is not a Medicare participating physician, the limit of the HCPP's liability is the
lower of the actual charge or the limiting charge permitted under the statute for FFS
Medicare. The HCPP is responsible for beneficiary coinsurance and deductible
payments.
History
(Rev. 30, 09-05-03)
Provenance
- Source
- cms.gov
- Retrieved
- 2026-08-25
- Edition
- iom-2026-08-25
- Content hash
780d7eb217ab7b1b55afb09f1b877cb609a0594d752a46b2715bdf915101879b
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.