A. Customary charge for a given medical service

Official source

The customary charge is the amount which best represents the actual charges made for a given medical service by a physician to the physician's patients in general, or by suppliers of other medical and health services to the general public. The carrier obtains information on the customary charges of physicians and suppliers not only from the Medicare program, but from other available sources, e.g., from its own programs, from other insurance programs, from the Federal Employee Health Benefit Program, from TRICARE, from any studies conducted by State or local medical societies, and from public agencies. It also may ask physicians or other persons for their charges for services rendered to the public in general.

In instances where physicians or suppliers feel that the carrier does not have sufficient current information about their charges, they may volunteer this information to the carrier. Further, carriers make known their willingness to receive currently valid information regarding customary charges from the medical community. However, any information on charges obtained from other sources is validated, to the extent possible, against the carrier’s claims experience under Medicare and its own programs.

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A. Customary charge for a given medical service

Official source

The customary charge is the amount which best represents the actual charges made for a given medical service by a physician to the physician's patients in general, or by suppliers of other medical and health services to the general public. The carrier obtains information on the customary charges of physicians and suppliers not only from the Medicare program, but from other available sources, e.g., from its own programs, from other insurance programs, from the Federal Employee Health Benefit Program, from TRICARE, from any studies conducted by State or local medical societies, and from public agencies. It also may ask physicians or other persons for their charges for services rendered to the public in general.

In instances where physicians or suppliers feel that the carrier does not have sufficient current information about their charges, they may volunteer this information to the carrier. Further, carriers make known their willingness to receive currently valid information regarding customary charges from the medical community. However, any information on charges obtained from other sources is validated, to the extent possible, against the carrier’s claims experience under Medicare and its own programs.