Updating Customary and Prevailing Charges

80.2 - Updating Customary and Prevailing Charges (Rev. 1, 10-01-03) B3-5003 A/B MACs (B)/DME MACs update customary and prevailing charge limits at the beginning of each fee screen year (the 12-month period beginning January), using available statistics on charges for services from claims processed or services rendered during the 12- month period ending June 30 immediately preceding the start of the fee screen year. For example, the limits used during fee screen year 2003 (January 1, 2003, through December 31, 2003) were based on the charges made from July 1, 2001, through June 30, 2002. Customary and prevailing charge screens for a fee screen year are not changed except for the following reasons: • In individually identified and highly unusual situations where equity clearly indicates that the increases are warranted and requested by the entity furnishing the service; • To correct erroneous calculations; or • To establish screens for new services. A/B MACs (B)/DME MACs must ensure that all data on the frequency of services, all data files and customary and prevailing charge files used to establish reasonable charge screens are retained and are available for use.