§489.32. Allowable charges: Noncovered and partially covered services.
42 C.F.R. § 489.32
Services requested by beneficiary. If services furnished at the request of a beneficiary (or his or her representative) are more expensive than, or in excess of, services covered under Medicare—
A provider may charge the beneficiary an amount that does not exceed the difference between—
The provider's customary charges for the services furnished; and
The provider's customary charges for the kinds and amounts of services that are covered under Medicare.
A provider may not charge for the services unless they have been requested by the beneficiary (or his or her representative) nor require a beneficiary to request services as a condition of admission.
To avoid misunderstanding and disputes, a provider must inform any beneficiary who requests a service for which a charge will be made that there will be a specified charge for that service.
Services not requested by the beneficiary. For special provisions that apply when a provider customarily furnishes more expensive services, see § 413.35 of this chapter.
Notes, amendments, and revision history
Amendments
[45 FR 22937, Apr. 4, 1980, as amended at 51 FR 34833, Sept. 30, 1986]
Authority
Authority: 42 U.S.C. 1302, 1395i-3, 1395x, 1395aa(m), 1395cc, 1395ff, and 1395hh.
Source
Source: 45 FR 22937, Apr. 4, 1980, unless otherwise noted.
Amendments
[45 FR 22937, Apr. 4, 1980, as amended at 51 FR 34833, Sept. 30, 1986]