Question:
Does a benefit category denial cause the financial liability protection provisions of Limitation On Liability (§1879) to be enacted?
Answer:
According to the Medicare Benefit Policy Manual, “A benefit category denial (i.e., a denial based on the fact that there is no benefit category under which the drug may be covered) does not trigger the financial liability protection provisions of Limitation On Liability (under §1879 of the Act). Therefore, physicians or providers may charge the beneficiary for an excluded drug.”
CPT® copyright 2024 American Medical Association (AMA). All rights reserved.
Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or not contained herein.
CPT is a registered trademark of the American Medical Association.
Subscribe to receive our News, Insights, and Compliance Question of the Week delivered right to your inbox.
Address: 5874 Blackshire Path, #13, Inver Grove Heights, MN 55076
Phone: (800) 252-1578
Email: support@medlearnmedia.com
Hours: 9am – 5pm CT
Copyright © 2025 MedLearn Publishing. Powered by MedLearn Media.
Unlock 50% off all 2024 edition books when you order by July 5! Use the coupon code CO5024 at checkout to claim this offer!
CYBER WEEK IS HERE! Don’t miss your chance to get 20% off now until Dec. 2 with code CYBER24