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If a provider uses two separate fee schedules, one for Medicare and one for the rest of his business, could he be liable for discrimination?


Assuming the Medicare fee schedule is the lower of the two, there is no discrimination from a regulatory standpoint. In fact, you should not charge a Non Medicare patient a fee lower than the fee you accept from Medicare.

From an operational standpoint, we do not recommend the use of two fee schedules unless you are a non-participating provider with Medicare and you are required to bill your limiting charge. (See our response to the Topic, Medicare Reimbursement) Otherwise, the use of a single fee schedule is recommended.


Russell Still (bio...)
Executive Vice President

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