Medicare excess charges: what a doctor can bill above the approved amount in 2026

Most of the dollars on a Medicare bill are fixed by the fee schedule, and the excess charge is the one slice a doctor can set. It exists only when three things line up: the doctor is not a participating Medicare provider, the doctor did not accept assignment on that claim, and the service is one the limiting charge covers. The figure at stake is smaller than most people fear. Across the twelve codes priced below, the excess runs from $2.21 for an electrocardiogram to $176.41 for the surgeon's fee on a total knee replacement, and it cannot be more than 14.25 percent of the fee schedule amount on any of them.

Why the ceiling is 109.25 percent of the fee schedule, not 115

Two rules multiply. The first is the payment cut. A participating doctor, one who signed the Medicare participation agreement, is paid 100 percent of the fee schedule and must accept assignment on every claim. Chapter 1 of the Medicare Claims Processing Manual, section 30.3, says nonparticipating providers are paid at 95 percent of the physician fee schedule and may accept assignment claim by claim. The manual describes the gap as a 5 percent reduction in the Medicare approved amount for a doctor who does not participate.

The second rule is the ceiling. Section 1848(g)(2)(C) of the Social Security Act, at 42 U.S.C. 1395w-4(g)(2)(C), sets the limiting charge after 1992 at 115 percent of the recognized payment amount for a nonparticipating physician. Paragraph (g)(1)(A) turns the number into a prohibition: no person may bill or collect an actual charge above the limiting charge, and no person is liable for any amount billed above it.

Multiply the two and 0.95 times 1.15 is 1.0925. The documentation that ships with the CMS relative value file says exactly this: the limiting charge is set at 115 percent of the payment amount for the nonparticipating physician, that amount is 95 percent of the fee schedule amount, and so the limiting charge is the fee schedule amount multiplied by 1.0925. The manual's own example in section 30.3.12.3 uses round numbers: a participating fee schedule amount of $2,000, a nonparticipating amount of $1,900, and a limiting charge of $2,185, which is $1,900 times 1.15.

The base matters. Applying 109.25 percent to the reduced 95 percent figure would count the payment cut twice and understate the ceiling by about 5 percent; the factor belongs on the full fee schedule amount. Medicare.gov and Medicare & You describe the ceiling as "15% above the Medicare-approved amount," and that is true when the approved amount is the 95 percent figure a nonparticipating doctor is paid. Measured against what a participating doctor would be paid, the same ceiling is 9.25 percent higher.

Two rounding details can move a published figure by pennies or a dollar. The CMS documentation multiplies the fee schedule amount by 1.0925 once. A contractor that rounds the 95 percent step to the cent first and then multiplies by 1.15 can land one cent away; for 99214 in Michigan Locality 01 the two routes give $149.10 and $149.11. And section 30.3.12.3 lets a provider round the limiting charge to the nearest dollar if it does so consistently for all services, so a bill a few cents or even under fifty cents above a table figure is not necessarily a violation. The tables here use the single multiplication and round to the cent, so a contractor's published file can differ from a cell by a single cent.

Twelve codes at the ceiling in Michigan Locality 01, 2026

The table prices the ceiling for a spread of common services: three office visits, an injection, an electrocardiogram, two imaging studies, a skin biopsy, a colonoscopy and three operations. Each fee schedule amount comes from the CY2026 relative value file (RVU26D, October 2026 release) weighted by the Michigan Locality 01 indices (work 1.000, practice expense 0.965, malpractice 1.686) and multiplied by the $33.4009 conversion factor. The setting column matters: the office codes use the nonfacility practice expense value, and the four surgical and endoscopy codes use the facility value, because that is the setting where the physician's fee is normally billed. The last column is the excess charge, the limiting charge minus the nonparticipating approved amount.

Source: CMS PFS RVU26D (PPRRVU2026_Oct_nonQPP, released 08/26/2026) and GPCI2026, Michigan Locality 01, CY2026, $33.4009 conversion factor. Limiting charge = fee schedule amount x 1.0925, per the RVU26D documentation; excess charge = limiting charge minus 95 percent of the fee schedule amount. The first eight rows are office amounts; the last four are the physician's professional fee only, and they carry the 090-day or 000-day global period listed in the file. Computed and checked November 3, 2026. Medicare anchors, not your bill.

Here is the arithmetic for 99214 so the table can be checked against the CMS file. RVU26D lists 1.92 work units, 2.00 nonfacility practice expense units and 0.14 malpractice units. At the Detroit indices that is 1.92 x 1.000 plus 2.00 x 0.965 plus 0.14 x 1.686, or 4.08604 adjusted units. Times $33.4009 that is $136.48. Ninety-five percent of $136.48 is $129.66, and 1.0925 times $136.48 is $149.10. The difference, $19.44, is the most a nonparticipating doctor can add to the approved amount for one 99214 visit.

The overlap with the rest of this site is a useful check. The fee schedule amounts for 45378, 71046 and 73721 are the same figures shown on the colonoscopy, chest X-ray and knee MRI price pages ($172.49, $32.64 and $200.97), because both pages read the same CMS file for the same locality. The excess charge is the layer above them. The excess charge is 14.25 percent of the fee schedule amount on every row, since 1.0925 minus 0.95 is 0.1425, so the dollar amounts scale straight with the service. A $15.51 electrocardiogram can carry $2.21. A $1,237.92 knee replacement fee can carry $176.41.

Two of these rows are global amounts that bundle a technical and a professional piece: the chest X-ray (71046) and the knee MRI (73721). The limiting charge reaches diagnostic tests whoever bills them; the manual's list in section 30.3.12.3 includes physicians' services, services and supplies furnished incident to a physician's services, outpatient therapy from independently practicing physical and occupational therapists, diagnostic tests and radiation therapy. Section 30.3.1 adds that acceptance of assignment is not mandatory for suppliers of radiology services or diagnostic tests, so an imaging center that does not participate can be a source of an excess charge too.

Show the numbers behind this figure

Arrangement	Medicare pays	You pay 20 percent	Excess charge	Total billed
Participating doctor	$109.18	$27.30	$0.00	$136.48
Nonparticipating, assigned	$103.73	$25.93	$0.00	$129.66
Nonparticipating, unassigned	$103.73	$25.93	$19.44	$149.10

Who gets the money, and what the doctor owes you when the bill is too high

The three bars differ in more than the total. A participating doctor, or a nonparticipating one who accepts assignment on this claim, bills Medicare, waits for Medicare's payment and asks you only for the deductible and coinsurance. Medicare & You says a provider who accepts assignment must submit the claim directly to Medicare and cannot charge you for submitting it. The unassigned route runs the other way. Medicare.gov says you might have to pay the full amount at the time of service, and that the doctor should still submit the claim to Medicare and cannot charge you for doing so. Section 30.3.2 of the manual says payment on an unassigned claim is made directly to the beneficiary, so Medicare's share comes to you, not to the doctor.

Source: CMS PFS RVU26D and GPCI2026, Michigan Locality 01, CY2026; Medicare Claims Processing Manual chapter 1, sections 30.3 and 30.3.2; Medicare.gov, Does your provider accept Medicare as full payment. Computed November 3, 2026. Medicare anchors, not your bill.

The bottom row is the cash arithmetic most readers have never seen. You pay $149.10 to the office, Medicare mails you $103.73, and the $45.37 you keep out of pocket is the $25.93 coinsurance plus the $19.44 excess. Against the participating row that is $18.07 more for the same visit, which is about 13.25 percent of the $136.48 fee schedule amount: 1.0925 minus the 0.76 of the fee schedule amount that Medicare pays (80 percent of 95 percent), minus the 0.20 a participating patient pays.

Statute and manual add rules that protect the patient on this route. A doctor who files for a patient cannot charge for the form: section 1848(g)(4) of the Act requires the claim within a year and bars any charge for completing it. If the doctor refuses to file, Medicare.gov says you can file the claim yourself. Section 30.3.2 of the manual adds a rule against splitting. A nonparticipating doctor may accept assignment on some services and not others, but may not "fragment" bills, meaning accept assignment on part of what was done at one place on one occasion and bill you the higher charge on the rest.

When a bill runs past the ceiling, paragraph (g)(1)(A) of the statute gives the remedy in four parts. No person is liable for the amount above the limiting charge. A bill that is too high must be reduced on a timely basis. An amount already collected above the limiting charge must be refunded, reduced by whatever balance the patient still owes that doctor. And the Secretary may apply sanctions where a doctor knowingly and willfully does it repeatedly or ignores the correction or refund duty. Paragraph (g)(1)(C) says a reduction or refund counts as timely if made within 30 days after the Medicare contractor notifies the doctor of the violation.

One more mechanical point comes from the same chapter and is worth a question to your plan. The manual's list of benefits of participating says that under the mandatory Medigap crossover process, beneficiaries must assign payment to a participating provider for the claim to be forwarded automatically to the Medigap insurer. The manual text on this is older than the rest of the chapter, and processes change, so treat it as a reason to ask rather than a rule: with an unassigned claim, ask your Medigap insurer whether it receives the claim from Medicare or wants a copy of the Medicare Summary Notice from you.

Plan G, Plan N or nothing: who holds the excess

Only Medigap Plans F and G pay Part B excess charges. The chart in Medicare & You 2027, which prints 2026 amounts, shows 100 percent of Part B excess charges under F and G and an empty box for every other lettered plan, and its instructions say an empty box means the service is not covered by that plan. Plan F is closed to people who became eligible for Medicare on or after January 1, 2020, while Plan G remains available to them. Plan N pays 100 percent of the Part B coinsurance, but the handbook adds that you pay a copayment of up to $20 for some office visits and up to $50 for emergency room visits that do not end in admission. In Massachusetts, Minnesota and Wisconsin Medigap policies are standardized differently, and the letters do not apply the same way.

No supplement means Original Medicare alone. The next table prices the same twelve services for a patient whose Part B deductible is already met, whose doctor is nonparticipating and has not accepted assignment on the claim, and who bills at exactly the limiting charge. The participating column is the comparison point: what the same service costs when the doctor accepts the approved amount.

Source: CMS PFS RVU26D and GPCI2026, Michigan Locality 01, CY2026; Medicare & You 2027 (CMS), Medigap chart of 2026 amounts, page 80. * Plan N also leaves a copayment of up to $20 for some office visits; the copayment is not added here because the handbook does not say which visits. All columns assume the $283.00 Part B deductible for 2026 is met and that Plan G has no high-deductible feature. Computed November 3, 2026. Medicare anchors, not your bill.

The Plan G column is zero by construction, and it is the reason excess charges are a small topic for people who hold that plan: the policy pays the 20 percent coinsurance and the excess, and the only Part B cost left is the annual deductible. The caveat is the high-deductible version of Plans F and G sold in some states. The handbook says you must pay up to $2,950 in 2026 for covered costs before such a policy starts to pay, so within that threshold a patient in the high-deductible plan is in the "no supplement" column.

The Plan N column assumes the policy pays the 20 percent coinsurance on the approved amount in full, so what is left is the excess charge, plus the copayment on some office visits. Take a 99214 visit. The 20 percent coinsurance of $25.93 is paid by the policy, the excess of $19.44 is not, and the policy's copayment of up to $20 can apply on top because it is an office visit. The no-supplement column is the full $45.37. For the knee replacement fee, where the office-visit copayment does not arise, Plan N holds $176.41 and no supplement holds $411.61, against $247.58 for a participating surgeon.

The three columns can be added into a year. Suppose six 99214 visits, one knee MRI (73721) and one joint injection (20610), all from nonparticipating doctors who do not accept assignment, with the deductible already met. Billed at the limiting charge, the eight services come to $1,191.10. With no supplement the patient keeps $362.45 out of pocket, made of $207.14 in coinsurance and $155.31 in excess charges. A participating doctor for the same eight services would leave $218.08, so the unassigned route costs $144.37 more over the year. Plan N pays the $207.14 of coinsurance and leaves the $155.31 excess, plus any copayments on the six office visits. Plan G pays all of it.

Practitioners and patients that excess charges never reach

The limiting charge belongs to physicians and the practitioners who are free to choose their participation status. Section 30.3.1 of the manual lists those who must accept assignment on every Medicare claim for their services, and for them the Medicare allowed amount is payment in full and the patient's liability is the deductible plus 20 percent. The list covers physician assistants, nurse practitioners, clinical nurse specialists, certified nurse midwives, certified registered nurse anesthetists, anesthesiologist assistants, clinical psychologists, clinical social workers, registered dietitians and nutritionists, marriage and family therapists, and mental health counselors. The manual's later section 30.3.12.1 repeats the practitioner list and says the nonparticipating fee schedule amounts and limiting charges do not apply to services these practitioners furnish.

The same section 30.3.1 lists services that are assigned by rule whoever provides them: clinical diagnostic laboratory services and physician laboratory services, ambulatory surgical center services, drugs and biologicals, and ambulance services. Two of these matter for a surgery bill. The surgeon's own fee is a physician service, so it can carry an excess charge when the surgeon is nonparticipating and does not accept assignment, but the surgery center's facility fee is assigned by rule and cannot. The comparison of surgery centers and hospital outpatient departments covers how that facility layer is priced, and the guide to Medicare outpatient procedure costs walks through the hospital copayment that sits next to the professional fee. An eye injection shows the same split on one claim: the eye injection cost guide prices the drug line, which is assigned by rule, beside the 67028 administration line, a physician service that can carry an excess charge.

Patients are protected too. Section 1848(g)(3) of the Act says payment for a physician's services to a person enrolled in Part B who is also eligible for medical assistance under a state Medicaid plan, including as a qualified Medicare beneficiary, can be made only on an assignment-related basis. A person who bills such a patient other than on an assigned basis is not owed the money, and a knowing and willful violation can bring sanctions. For a patient on a Medicare Savings Program the Medicare allowed amount is therefore the ceiling, not the limiting charge. The guide to Medicare Savings Programs explains how enrollment works.

Two situations look like an excess charge and are not. A doctor who has opted out of Medicare is outside the system: Medicare pays nothing for any service from that doctor, except in an emergency or urgent need, and patient and doctor agree terms in a private contract. Medicare.gov says opt-outs last at least two years and suggests contacting your State Health Insurance Assistance Program (SHIP) before signing one. The second is a service Medicare does not cover at all, where no Medicare amount exists to exceed. The guide to the Advance Beneficiary Notice covers the notice that lets a provider bill a patient for a service Medicare is expected to deny, a separate rule from the limiting charge. And a Medicare Advantage plan is a different arrangement entirely: Medicare & You says you get most of your Part A and Part B coverage from the plan, not Original Medicare, so the plan's own cost sharing and network rules govern, and the plan's Evidence of Coverage is the document to read.

Office, facility and the surgeon's fee

The setting changes which fee schedule amount the ceiling sits on. RVU26D defines a nonfacility amount, used when the service is furnished in an office, and a facility amount, used in a hospital, a surgery center and other facility settings, where the facility supplies the space and staff. Section 30.3.12.1 of the manual says the limiting charge is computed for both settings: 115 percent of the nonparticipating fee for each. The colonoscopy shows how much the setting moves the number. In a facility, 45378 has a fee schedule amount of $172.49, a limiting charge of $188.45 and an excess of $24.58. In an office endoscopy suite the same code carries the nonfacility practice expense, a fee schedule amount of $378.46, a limiting charge of $413.47 and an excess of $53.93. The other three operations in the table, 66984, 29881 and 27447, are facility-only in the file: the CMS documentation marks codes that are never or rarely done outside a facility with "NA" in the nonfacility field, and notes that many major procedures with a 90-day global period are almost always performed in the hospital inpatient setting. For a quote from a surgeon's office, the useful question is which fee it is: the professional fee, in the facility setting, with the facility's own charge billed separately.

The three operations in the table also carry global periods in the CMS file: 090 days for the cataract removal (66984), the arthroscopy (29881) and the knee replacement (27447), and 000 for the colonoscopy (45378). The CMS documentation defines 090 as major surgery with a 1-day preoperative period and a 90-day postoperative period included in the fee schedule amount, and 000 as an endoscopic or minor procedure with the related work on the day of the procedure included. The limiting charge sits on that bundled fee schedule amount, so the ceiling for a nonparticipating surgeon is one figure for the whole package, not a figure per visit. The surgeon's fee is one of at least four layers on a surgery bill: the facility fee, the anesthesia professional, the pathology lab if tissue is examined, and the surgeon. The guide to how the anesthesia bill is calculated shows the anesthesia layer, which follows its own formula.

Geography moves the dollar amounts but not the percentages. The next table applies the CY2026 indices for eight localities to the same RVU26D values for an office visit and for the knee replacement fee.

Source: CMS PFS RVU26D relative value units and CY2026 GPCI file (Addendum E of the CY2026 final rule), $33.4009 conversion factor; 99214 at the nonfacility amount and 27447 at the facility amount. Computed November 3, 2026. Medicare anchors, not your bill.

The 99214 excess runs from $17.82 in Mississippi to $24.22 in Alaska. The knee replacement excess runs from $148.98 in Iowa to $205.68 in Alaska. Neither is a locality-specific rule; each is 14.25 percent of that locality's fee schedule amount. The Medicare contractor for your area publishes its own fee schedule file with the participating, nonparticipating and limiting-charge amounts for every code, because section 30.3.12.1 of the manual tells contractors to produce fee disclosure reports that list the participating amount, the nonparticipating amount and the limiting charge for the nonfacility and facility settings.

State rules above the federal ceiling, read from official texts on November 3, 2026

Federal law sets the ceiling, and states can set a lower one on the doctors they license. The lists that circulate online disagree about which states do, because the state rules are different kinds of rule: a licensing condition, a flat statutory ban, a percentage cap, a disciplinary clause, a notice requirement. The table below is built from the text of each statute on the state's own legislative site, and it describes what the text does, not what a list says it does.

Sources: the statutes linked in the table, on malegislature.gov, revisor.mn.gov, palegis.us, nysenate.gov, webserver.rilegislature.gov, cga.ct.gov and legislature.vermont.gov. The New York page showed its most recent revision as September 22, 2014. Texts read November 3, 2026. General information, not legal advice; a statute can be amended after the date shown.

Three of the rows are outright bans, and they differ in who they bind. Massachusetts works through the physician's registration: a physician who agrees to treat a Medicare beneficiary must also agree not to charge or collect more than the reasonable charge the federal Secretary determines. Minnesota reaches any health care provider but only for Medicare beneficiaries who are Minnesota residents, and it stepped down from 115 percent in 1993 to 100 percent of the Medicare-approved amount on January 1, 1996; ambulance services and medical supplies and equipment are carved out. Pennsylvania's Health Care Practitioners Medicare Fee Control Act, Act 81 of 1990, makes balance billing unlawful for any licensed health care practitioner, and for the corporation or facility that employs one, with a public reprimand and repayment with interest for a first violation and fines of $2,000, then $5,000, then more for later ones.

Two details in those texts need care. Massachusetts and Pennsylvania both measure the limit against the "reasonable charge" determined by the federal Secretary, wording from before 1992, when the fee schedule replaced reasonable charges; the Minnesota text says the "Medicare-approved amount." Whether a nonparticipating doctor in these states may bill 95 percent or 100 percent of the fee schedule amount is not something the texts spell out, and this site does not decide it. The practical point holds either way: the state number is below the 109.25 percent ceiling, so the excess charge in the tables above does not apply to the covered practitioners in these three states. Pennsylvania's definition of a covered practitioner is broad enough to name chiropractors, physical therapists and nurses, which is wider than the physician-only wording elsewhere.

New York is a cap, not a ban. Section 19 of the Public Health Law says a physician licensed under Education Law article 131 may not charge a Medicare beneficiary more than 110 percent of the federal reasonable charge from January 1, 1993, or 105 percent if the statewide share of Part B claims billed at or below the reasonable charge failed to rise by five percentage points for federal fiscal year 1992 against 1989. The page does not say which tier is in force. It also exempts office and home visits as defined by procedure codes 90000 through 90170 in the 1989 CPT. How that 1989 range maps to 99213, 99214 and 99204 is not something this site can settle, so the New York cap should not be applied to the three office-visit rows without asking. Penalties run from fines of up to $1,000 for a first violation to up to $5,000 for repeat violations within five years, with refund of the excess.

Rhode Island and Connecticut are where the lists most often mislead. Rhode Island's section 5-37-5.1(29) lists, among the grounds of unprofessional conduct for a physician, agreeing to treat a Medicare beneficiary and then charging or collecting any amount in excess of the amount or amounts permitted pursuant to the Medicare Act. Because the Medicare Act permits the limiting charge, the clause enforces the federal ceiling through the medical board; it does not, on its face, set a lower one. In Connecticut's chapter 370, the only provision on Medicare assignment is section 20-14k, which requires a physician to post the office's Medicare assignment policy and tell eligible patients before care. There is no dollar cap in that text.

Vermont is a ban with exceptions. Section 6502 of Title 33 says a physician who agrees to treat a Medicare or General Assistance beneficiary may not balance bill, and section 6501 defines balance billing as charging or collecting any amount above the reasonable charge. Section 6503 allows balance billing in three cases: when the beneficiary, or a spouse living with them, received Social Security or railroad retirement benefits that were subject to federal income tax in the prior calendar year, or would have owed tax on them had they received them; when the beneficiary refuses to sign the statement that section 6504 lets the physician request; and for office and home visits, defined as codes 90000 through 90170 in the 1986 edition of CPT. Section 6504 adds that the taxable-benefits exception does not apply if the physician does not ask the beneficiary to sign that statement. Like Massachusetts and Pennsylvania, Vermont measures against the reasonable charge. A household with taxable Social Security income, a patient who declines to sign and an office visit can each fall outside the ban, so the row does not mean no excess charges in Vermont.

Ohio turns up on some consumer lists of states that limit excess charges. It is not in the table, because no official Ohio statute text is cited here, and nothing on this site says what Ohio requires. A state missing from the table may still have a rule. The State Health Insurance Assistance Program in each state can say what applies.

Checking one bill against the ceiling

The tables give the ceiling for these codes in one locality. For any other service and place, three numbers decide whether an excess is legal: what the office billed for the CPT code, the fee schedule amount for that code in your locality, and 1.0925 times it. The fee schedule amount is on the Medicare contractor's published fee schedule for your locality, which lists the nonparticipating and limiting-charge amounts alongside the participating one, and the Medicare Summary Notice shows the amount Medicare approved on your claim. If the notice's approved amount is 95 percent of the participating figure, the doctor is nonparticipating on that claim.

Before the visit, the questions are short. Is the doctor a participating Medicare provider? If not, will the office accept assignment on this claim, and will it accept assignment for the whole visit, not part of it? What is the charge for each CPT code, and is that at or below the limiting charge? Will the office file the claim with Medicare, and will it give a receipt with the codes? Medicare.gov's page on assignment suggests checking whether a provider accepts assignment before care. The chiropractor guide applies the same questions to a practitioner type that can be nonparticipating, with the 98941 limiting charge worked through.

After the bill, the order is: compare the charge to the ceiling; if it is above, ask the office to reduce it in writing, citing section 1848(g)(1) of the Social Security Act; if you already paid, ask for the refund of the amount above the limiting charge; and if the office does not respond, call 1-800-MEDICARE, which the handbook gives as the number for help with a provider who will not file a claim. In a state with its own rule the state's licensing board or a SHIP counselor is the place to ask. None of this requires proving anything about the care; it is arithmetic on a billed amount.

Whether an excess charge is worth avoiding is a question of dollars, not of care, and the tables give the scale. For the three office visits in the table it runs from $13.62 to $25.65 a visit; for the knee replacement fee it runs from $148.98 to $205.68 across the eight localities. A reader who holds Plan G will not feel any of it. For 99214 in Michigan Locality 01 with the deductible met, a patient with Plan N or no supplement who owes the full excess pays $18.07 more per visit than a patient of a participating doctor.

Questions about Medicare excess charges

Where the ceiling and each dollar amount come from

• CMS, Physician Fee Schedule relative value file RVU26D (October 2026 release, PPRRVU2026_Oct_nonQPP released 08/26/2026) and CY2026 GPCIs: work, practice expense and malpractice units, status A, global periods, the payment formula, the $33.4009 conversion factor and the limiting charge explanation (95 percent of 115 percent, a factor of 1.0925). Computed November 3, 2026.
• U.S. Code, 42 U.S.C. 1395w-4 (2024 edition, govinfo.gov), subsections (g)(1) limitation on actual charges and refund, (g)(2) limiting charge, (g)(3) Medicaid-eligible beneficiaries and (g)(4) claim submission. Checked November 3, 2026.
• CMS, Medicare Claims Processing Manual, chapter 1 (Rev. 13725, issued 04-10-26), sections 30.3 (participation and assignment), 30.3.1 (mandatory assignment), 30.3.2 (nature and effect of assignment), 30.3.12 and 30.3.12.1 (participation program, fee disclosure, practitioners subject to mandatory assignment) and 30.3.12.3 (carrier rules for limiting charge). Checked November 3, 2026.
• CMS, Medicare & You 2027: assignment and the limiting charge (Section 3), opt-out providers and private contracts, and the Medigap chart of 2026 amounts (Section 5, page 80). Checked November 3, 2026.
• Medicare.gov, Does your provider accept Medicare as full payment and Medicare costs (2026 Part B deductible of $283.00). Checked November 3, 2026.
• Massachusetts General Laws, chapter 112, section 2; Minnesota Statutes 62J.25; Pennsylvania Act 81 of 1990, Health Care Practitioners Medicare Fee Control Act; New York Public Health Law section 19; Rhode Island General Laws 5-37-5.1; Connecticut General Statutes chapter 370, section 20-14k. Read November 3, 2026.

General billing information, not medical, legal or insurance advice. Medicare anchors are not your bill, and a doctor's own charges can differ from them within the limits described here. State statutes can change; confirm a state rule with the state or a SHIP counselor. Confirm your price in writing before service.