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 locale” and/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
Covered Expenses will only be payable at the Usual and Customary level of payment; and2.
Benefits will not be paid in excess of the Usual and Customary Charges.
Maximum allowable fee as used in the PPO and Usual and Customary fee as used in the Basic and HSP plans are intended to be synonymous terms.
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.
If a person is covered by 2 or more Coverage Plans that compute their benefit payments on the basis of Usual and Customary fees, any amount in excess of the highest of the Usual and Customary fees for a specific benefit is not an allowable expense.
More Definitions of Usual and Customary
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 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(s) for medical services or supplies which is (are):
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.
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. (U&C) shall mean Covered Services which are identified by the Plan Administrator, taking into consideration the charge(s) which the provider most frequently bills the majority of patients for the service or supply, the cost to the provider for providing the service or supply, the prevailing range of charges billed in the same “area” by providers of similar training and
Usual and Customary means the lowest price each pharmacy in the CPN would charge to a Patient if the Patient were paying cash for the identical Formulary Drug on 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.