---
kind: "section"
citation: "42 C.F.R. § 405.2410"
title: "42"
number: "405.2410"
heading: "Application of Part B deductible and coinsurance."
url: "https://uscodex.org/cfr/42/405.2410"
---

# §405.2410. Application of Part B deductible and coinsurance.

- (a) **Application of deductible.**
  - (1) **Medicare payment for RHC services begins only after the beneficiary has incurred the deductible.**
  - (2) Medicare payment for services covered under the FQHC benefit is not subject to the usual Part B deductible.
- (b) **Application of coinsurance.** Except for preventive services for which Medicare pays 100 percent under [§ 410.152(l)](/cfr/42/410.152.md?p=l) of this chapter, a beneficiary's responsibility is either of the following:
  - (1) **For RHCs that are authorized to bill on the basis of the reasonable cost system—**
    - (i) A coinsurance amount that does not exceed 20 percent of the RHC's reasonable customary charge for the covered service; and
    - (ii)
      - (A) The beneficiary's deductible and coinsurance amount for any one item or service furnished by the RHC may not exceed a reasonable amount customarily charged by the RHC for that particular item or service; or
      - (B) For any one item or service furnished by a FQHC, a coinsurance amount that does not exceed 20 percent of a reasonable customary charge by the FQHC for that particular item or service.
  - (2) **For FQHCs authorized to bill under the PPS, a coinsurance amount which is 20 percent of the lesser of—**
    - (i) The FQHC's actual charge; or
    - (ii) **The FQHC PPS rate for the covered service.**
- (c) **Application of deductible and coinsurance for RHCs and FQHCs paid on the basis of the special payment rule described under § 405.2462(j).**
  - (1) For RHCs, the coinsurance amount is determined as described in [paragraph (b)(1)](#b-1) of this section; or
  - (2) **For FQHCs, the coinsurance amount is 20 percent of the lesser of—**
    - (i) The FQHC's actual charge; or
    - (ii) The payment determined under [§ 405.2462(j)(2)](/cfr/42/405.2462.md?p=j-2).

## Notes

### Amendments

[71 FR 55345, Sept. 22, 2006, as amended at 79 FR 25474, May 2, 2014; 80 FR 71371, Nov. 16, 2015; 88 FR 82176, Nov. 22, 2023; 89 FR 98553, Dec. 9, 2024]

### Authority

Authority: Secs. 1102 and 1871 of the Social Security Act (42 U.S.C. 1302 and 1395hh).

### Source

Source: 43 FR 8261, Mar. 1, 1978, unless otherwise noted.

### Authority

Authority: 42 U.S.C. 263a, 405(a), 1302, 1320b-12, 1395x, 1395y(a), 1395ff, 1395hh, 1395kk, 1395rr, and 1395ww(k).

### Amendments

[71 FR 55345, Sept. 22, 2006, as amended at 79 FR 25474, May 2, 2014; 80 FR 71371, Nov. 16, 2015; 88 FR 82176, Nov. 22, 2023; 89 FR 98553, Dec. 9, 2024]