Limiting charge
The 115 percent figure is the federal limiting charge. A state may set a tighter cap. The CMS manual controls the calculation.
Source: Medicare.gov, Does your provider accept Medicare as full payment? Page read October 14, 2026.
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Definition · Medicare program and benefits
Limiting charge
The limiting charge is the cap on what a nonparticipating provider who does not accept assignment may collect for a Medicare-covered service. Medicare sets it at 115 percent of the nonparticipating fee schedule amount. It does not apply when the provider accepts assignment. This page does not compute a charge.
Questions
Limiting charge, answered
Does the limiting charge apply to Medicare Advantage?
No. The limiting charge is an Original Medicare rule for nonparticipating providers. A Medicare Advantage plan uses its own network rules.