For a nonPAR who bills Medicare with a submitted charge of $650 and a nonPAR Medicare physician fee schedule allowed amount of $450, what is the Medicare payment?

To determine the Medicare payment for a non-participating provider (nonPAR) who has billed Medicare, we need to understand how payments are calculated for nonPAR providers under the Medicare fee-for-service program.

When a nonPAR bills Medicare, they are paid 95% of the Medicare fee schedule amount allowed for their services. In this scenario, the allowed amount for the service provided is $450. To calculate the payment:

1. Determine 95% of the allowed amount:

[

Payment = Allowed Amount \times 0.95 = 450 \times 0.95 = 427.50

]

2. Because the submitted charge ($650) exceeds the allowed amount, the provider will receive the lower of the determined payment or the allowed amount. Therefore, the payment will be:

[

Payment = 427.50

]

However, the calculation also needs to consider the patient's responsibility. In typical cases, there are deductions such as coinsurance, and since the specific details on additional costs (like co-pays or deductibles) have not been provided in the question, we cannot make adjustments based on that for this calculation.

Thus, the correct Medicare payment for the described scenario is indeed