Who determines UCR?

“Usual, customary and reasonable” refers to the maximum usual and customary charge a payor considers reasonable. Providers set UC charges and apply those charges uniformly. Each payor decides what it considers the UCR charge for a particular service in that market.

What is the "UCR" (Unified Carrier Registration)?

What is the meaning of usual and customary?

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.

What is a customary fee?

Most insurance plans will pay only what they call a reasonable and customary fee for a particular service. If your doctor charges $1,000 for a hernia repair while most doctors in your area charge only $600, you will be billed for the $400 difference.

What does UCR insurance determine?

The amount paid for a medical service in a geographic area based on what providers in the area usually charge for the same or similar medical service. The UCR amount sometimes is used to determine the allowed amount.

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What is a fee schedule?

A fee schedule is a complete listing of fees used by Medicare to pay doctors or other providers/suppliers. This comprehensive listing of fee maximums is used to reimburse a physician and/or other providers on a fee-for-service basis.

What is meant by a usual customary and reasonable basis?

The amount paid for a medical service in a geographic area based on what providers in the area usually charge for the same or similar medical service. The UCR amount sometimes is used to determine the allowed amount.

What is the usual fee?

Usual Fee means the fee charged the general public for a given service.

What is customary usage?

customary applies to what accords with the practices, conventions, or usages of an individual or community. the customary waiting period before the application is approved. habitual suggests a practice settled or established by much repetition.

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What is the meaning of customary action?

: commonly practiced, used, or observed. customary acts of courtesy. his customary enthusiasm. : based on or established by custom. customary laws.

What is customary payment?

Customary Fee means a fee that falls within the range of fees normally charged for a given service.

What is a reasonable fee?

a term that describes a fee that isn't too high or too low when it is compared with similar fees for a similar service.

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