What is scheduled fee?

• A. The amount Medicare will contribute to a procedure
• B. The total charge by the doctor for the procedure
• C. The maximum out-of-pocket cost for the patient
• D. The standard hospital admission fee

Answer: (A)

The scheduled fee is the amount Medicare uses as the government-set baseline for a medical service, and it determines how much Medicare will contribute toward that service. In practice, Medicare rebates a portion of this scheduled amount, and the patient may pay the difference if the doctor charges more than the schedule fee. For example, if the schedule fee for a procedure is $100 and Medicare covers a portion of that amount, the rebate might be $75, with the patient responsible for the remaining difference up to the doctor's actual charge. The hospital admission fee is a separate cost and not determined by the scheduled fee.