Certified Medical Administrative Assistants (CMAA) Practice Exam 2025 - Free CMAA Practice Questions and Study Guide

The Medicare fee schedule includes a participating fee, a nonparticipating fee, and a limited charge because it is designed to provide structured payment amounts to healthcare providers for services rendered to Medicare beneficiaries.

In this context, the participating fee refers to the fixed amount that healthcare providers who accept Medicare assignment agree to be paid for specific services. The nonparticipating fee is the amount that nonparticipating providers can charge, which is generally higher than the participating fee. Limited charge refers to the maximum amount that nonparticipating providers can bill Medicare beneficiaries above the Medicare allowed amount, ensuring that patients are not charged excessively.

This framework helps maintain uniformity in billing practices and ensures that Medicare beneficiaries have clear expectations regarding their costs for healthcare services. The details regarding fees and charges are specific to the Medicare program, which differentiates it from other fee schedules such as those used for private insurance, Medicaid, or negotiated payments. Each of those other schedules operates under different principles and structures, focusing more on their own payment methodologies without the defined categories present in the Medicare system.