For a nonparticipating physician who does not accept assignment, what is the maximum amount the physician can charge over the non-PAR Medicare Fee Schedule amount?

For a nonparticipating (non-PAR) physician who does not accept assignment, there are specific rules governing the maximum amount they can charge above the non-PAR Medicare Fee Schedule amount.

The maximum charge that a non-PAR physician can bill is limited to 115% of the Medicare fee schedule amount for that service. To determine the maximum allowed amount that can be charged, you take the non-PAR fee schedule amount and multiply it by 1.15.

If the calculated amount exceeds the limit for that specific service, the physician must adhere to the fee schedule limit imposed by Medicare. Therefore, in this scenario, the correct answer reflects the permissible billing practices for non-PAR physicians, providing a clear understanding of how fees are regulated and ensuring that billing remains compliant with Medicare guidelines.

The other amounts listed in the choices, although they might seem plausible, do not align with the established billing percentages applicable to nonparticipating providers within the Medicare system.