Payment for Services Rendered On or After April 1, 1994, by

40.1 - Payment for Services Rendered On or After April 1, 1994, by Noncontracted Medicare Participating Physicians (Rev. 30, 09-05-03) The limit of the HCPP's liability for services rendered by a physician with whom it does not contract depends on whether the physician is a Medicare participating physician (i.e., has agreed to accept assignment on all Medicare claims submitted to Medicare). The Medicare participation agreement is deemed to apply to such a physician's services in the sense that the physician may not bill the HCPP, the beneficiary, or any other party for any amount in excess of the Medicare allowed amount (the fee schedule amount or the actual charge, if lower). However, the HCPP has financial responsibility for the amount that would have been the beneficiary's liability in FFS Medicare (the 20 percent coinsurance and any unmet deductible). NOTE: The financial responsibility of the HCPP applies only when the services are covered by the HCPP, i.e., for emergency or urgently needed services or when the HCPP refers the enrollee to the non-network physician.