Medicare Part B Excess Charges
Last updated May 2026
The limiting charge rule
Non-participating Part B providers can charge up to 115% of the Medicare-approved amount on assigned and unassigned claims. The 15% over-Medicare amount is the 'excess charge.'
What it means for SNFs
Most SNFs accept assignment as participating providers, eliminating excess charges entirely. When a non-par arrangement exists, residents and supplemental insurers may be billed the limiting charge difference.
Participating vs non-participating
Participating providers accept the Medicare-approved amount as full payment and cannot bill excess charges. Non-par providers can bill the limiting charge but must still file the claim and accept the Medicare reimbursement directly when the claim is assigned. Most SNFs operate as participating providers for Part B supplies.
Resident balance-billing rules
When excess charges do apply, the resident or their Medigap policy is responsible for the difference. Some Medigap plans (Plan F and Plan G) cover the limiting charge; others do not. Facilities should disclose any potential balance-bill exposure in writing before dispensing.
How Burst handles it
Burst Billing files all SNF Part B supply claims as assigned under your facility's NPI as a participating provider. There are no excess charges in our claim flow, residents are never balance-billed beyond the standard Part B 20% coinsurance, which Medigap typically covers.
Talk to Burst about your SNF's supply reimbursement process
Schedule a reimbursement review with our team, no obligation, no upfront cost.
Frequently asked questions
- Generally no. Excess charges arise when a non-participating provider bills above the Medicare-approved amount. Facilities billing supplies under participation agreements bill the allowed amount.
- A secondary or Medigap policy where the resident has one, otherwise the resident, subject to deductible status. That balance is handled through your normal resident billing process.
- Yes, and it is why balance-billing rules matter. A resident cannot be billed above the applicable cost-sharing amount on a participating claim.
Related insights
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Read articleMedicare Quantity Limits for SNF Part B Supplies: The 3 Numbers to Check Before You Bill
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Read articlePrimary sources
Part B rules, audit triggers, and reimbursement policy referenced on this page come from the official sources below. Coverage policy changes; confirm current requirements with CMS and your Medicare Administrative Contractor before billing.
- Medicare.gov — Medicare costs, assignment, and the limiting charge
- CMS — Physician Fee Schedule
- CMS — Internet-Only Manuals (Medicare Claims Processing Manual, Pub. 100-04)
This page is general educational information, not legal, coding, or compliance advice. Burst does not guarantee reimbursement, claim approval, or any audit outcome.
Reviewed by Eric Hansen, Chief Executive Officer & Founder · July 2026. Cost-sharing and balance-billing statements were reviewed against participation agreement rules.
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