42 CFR 405.504 - Determining prevailing charges

Cite as42 CFR 405.504
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15 practice notes
  • Abbott Radiology Associates v. Shalala, No. 94-CV-390H.
    • United States
    • United States District Courts. 2nd Circuit. United States District Court of Western District of New York
    • November 20, 1997
    ...42 U.S.C. § 1395l(a)(1). Effective January 1, 1971, Medicare reimbursement rates were determined using a "reasonable charge" formula. 42 C.F.R. § 405.504(a)(2) (1977). Applying this methodology, a physician treating a Medicare patient would be paid the lower of: (1) the physician's actual c......
  • Bowen v. Michigan Academy of Family Physicians, No. 85-225
    • United States
    • United States Supreme Court
    • June 9, 1986
    ...Respondents, who include an association of family physicians and several individual doctors, filed suit to challenge the validity of 42 CFR § 405.504(b) (1985), which authorizes the payment of benefits in different amounts for similar physicians' services. The District Court held that the r......
  • Sensory Neurostimulation, Inc. v. Azar, No. 19-55036
    • United States
    • United States Courts of Appeals. United States Court of Appeals (9th Circuit)
    • October 16, 2020
    ...476 U.S. at 668–69, 106 S.Ct. 2133. That regulation determined rates at which physicians could recover for certain services. See 42 C.F.R. § 405.504(b) (1985). The Court explained that, because plaintiffs could not bring their challenges through any administrative channel, applying § 405(h)......
  • Pennsylvania Medical Soc. v. Marconis, Civ. A. No. 90-193 Erie.
    • United States
    • United States District Courts. 3th Circuit. United States District Court (Eastern District of Pennsylvania)
    • January 30, 1991
    ...complicated set of formulas found in the Medicare act, regulations and manuals. See 42 U.S.C. §§ 1395u(b)(3), 1395x(v); 42 CFR §§ 405.5029, 405.504; HHS, Medicare Carriers Manual, Part B, Ch. V (1987). Beginning in 1992, this system will be replaced by a national fee schedule. 42 U.S.C. § 3......
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15 cases
  • Abbott Radiology Associates v. Shalala, No. 94-CV-390H.
    • United States
    • United States District Courts. 2nd Circuit. United States District Court of Western District of New York
    • November 20, 1997
    ...42 U.S.C. § 1395l(a)(1). Effective January 1, 1971, Medicare reimbursement rates were determined using a "reasonable charge" formula. 42 C.F.R. § 405.504(a)(2) (1977). Applying this methodology, a physician treating a Medicare patient would be paid the lower of: (1) the physician's actual c......
  • Bowen v. Michigan Academy of Family Physicians, No. 85-225
    • United States
    • United States Supreme Court
    • June 9, 1986
    ...Respondents, who include an association of family physicians and several individual doctors, filed suit to challenge the validity of 42 CFR § 405.504(b) (1985), which authorizes the payment of benefits in different amounts for similar physicians' services. The District Court held that the r......
  • Sensory Neurostimulation, Inc. v. Azar, No. 19-55036
    • United States
    • United States Courts of Appeals. United States Court of Appeals (9th Circuit)
    • October 16, 2020
    ...476 U.S. at 668–69, 106 S.Ct. 2133. That regulation determined rates at which physicians could recover for certain services. See 42 C.F.R. § 405.504(b) (1985). The Court explained that, because plaintiffs could not bring their challenges through any administrative channel, applying § 405(h)......
  • Pennsylvania Medical Soc. v. Marconis, Civ. A. No. 90-193 Erie.
    • United States
    • United States District Courts. 3th Circuit. United States District Court (Eastern District of Pennsylvania)
    • January 30, 1991
    ...complicated set of formulas found in the Medicare act, regulations and manuals. See 42 U.S.C. §§ 1395u(b)(3), 1395x(v); 42 CFR §§ 405.5029, 405.504; HHS, Medicare Carriers Manual, Part B, Ch. V (1987). Beginning in 1992, this system will be replaced by a national fee schedule. 42 U.S.C. § 3......
  • Request a trial to view additional results

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