Medicare Approved Amount
The Medicare-approved amount is the payment set by Medicare's fee schedule for a covered service, reflecting factors such as clinical work, practice cost, and malpractice expense. For most Part B services, Medicare pays 80 percent of the approved amount and the beneficiary is responsible for the remaining share.
Definition
The Medicare-approved amount is the payment set by Medicare's fee schedule for a covered service, reflecting factors such as clinical work, practice cost, and malpractice expense. For most Part B services, Medicare pays 80 percent of the approved amount and the beneficiary is responsible for the remaining share.
Why it matters
It anchors beneficiary coinsurance and provider payment, and limits on charges above it protect patients from excessive balance billing.
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