Usual and Customary definition

Usual and Customary. (U&C) shall mean covered expenses which are identified by the Plan Administrator, taking into consideration the fee(s) which the Provider most frequently charges the majority of patients for the service or supply, the cost to the Provider for providing the services, the prevailing range of fees charged in the same “area” by Providers of similar training and experience for the service or supply, and the Medicare reimbursement rates. The term(s) “same geographic localeand/or “area” shall be defined as a metropolitan area, county, or such greater area as is necessary to obtain a representative cross-section of Providers, persons or organizations rendering such treatment, services, or supplies for which a specific charge is made. To be Usual and Customary, fee(s) must be in compliance with generally accepted billing practices for unbundling or multiple procedures.
Usual and Customary means the comparable level of charges for similar treatment, services and supplies in the geographic area where treatment, services or supplies are provided or performed.
Usual and Customary charges means the following:

Examples of Usual and Customary in a sentence

  • Usual and Customary means the comparable level of charges for similar treatment, services and supplies in the geographic area where treatment, services or supplies are provided or performed.

  • If possible, Your Common Carrier tickets will be used.We will also pay a benefit for Usual and Customary expenses incurred for a Medical Escort’s transportation and accommodations if an onsite attending Physician recommends in writing that a Medical Escort accompany You.

  • Medical Evacuation expenses will only be payable at the Usual and Customary level or payment for necessary transportation, related medical services and medical supplies.

  • Payment for a particular Outpatient Service shall be equal to the product of the Cost-to-Charge Ratio times HRC’s Usual and Customary Charge for the Outpatient Service.

  • We will not pay benefits in excess of the Usual and Customary level of charges.


More Definitions of Usual and Customary

Usual and Customary or “U&C” means the amount a participating provider would charge to a cash paying customer for same strength, quantity, and dosage form of a covered drug, as of the date the prescription is filled.
Usual and Customary means the fee that the provider usually charges nonmedicaid customers for the same service or item. This is the maximum amount that the provider may bill the agency.
Usual and Customary means the fee(s) for medical services or supplies which is (are):
Usual and Customary means the lowest price each Contract Pharmacy would charge to a Patient if the Patient were paying cash for the identical Formulary Drug of the same date of services. This includes any applicable discounts including, but not limited to, senior discounts, frequent shopper discounts and other special discounts offered to customers, inclusive of the dispensing fee.
Usual and Customary means the charge that is associated with a medical or a surgical supply, a service, a procedure or a prescription drug that is used to calculate the eligible allowance for a non-preferred provider. This charge represents the normal charge level at the 70th percentile for that procedure in the geographic area of service. Usual and Customary allowances are derived from a national database that is updated at least annually. The geographic area of service is determined by the number of similar providers in a zip code range. For the purpose of air Ambulance services, the Usual and Customary amount shall be limited to 250% of the amount that is allowed by Medicare.
Usual and Customary means the fee regularly charged and received for a given service by a health care provider when furnishing customary treatment for a similar condition or Injury as represented by the 70th percentile of the Ingenix MDR database. We shall provide to a Covered Person, upon his written request, an estimate of the amount We will pay for a particular procedure or service. However, We will not be bound by such good faith estimate.
Usual and Customary means the charge associated with a medical or surgical supply, service, procedure or Prescription Drug which represents the normal charge level for that procedure in the geographic area of service.