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For services and procedures performed by non-participating fee-for service providers (i.e., those providers who opt out of Medicare assignment), the total Medicare allowed amounts for servicers and procedures are slightly lower (5% lower) compared to Medicare allowed amounts for participating providers. However, while participating providers can only charge Medicare beneficiaries a coinsurance amount up to 20% of the Medicare allowed amount, non-participating providers can charge beneficiaries the 20% coinsurance plus an additional amount up to a total of 115% of their reduced allowed amount (this is referred to as the limiting charge portion).
(FAQ9920)
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