§ 405.500 Basis
§ 405.501 Determination of reasonable charges
§ 405.502 Criteria for determining reasonable charges
§ 405.503 Determining customary charges
§ 405.504 Determining prevailing charges
§ 405.505 Determination of locality
§ 405.506 Charges higher than customary or prevailing charges or lowest charge levels
§ 405.507 Illustrations of the application of the criteria for determining reasonable charges
§ 405.508 Determination of comparable circumstances; limitation
§ 405.509 Determining the inflation-indexed charge
§ 405.511 Reasonable charges for medical services, supplies, and equipment
§ 405.512 Carriers’ procedural terminology and coding systems
§ 405.515 Reimbursement for clinical laboratory services billed by physicians
§ 405.517 Payment for drugs and biologicals that are not paid on a cost or prospective payment basis
§ 405.520 Payment for a physician assistant’s, nurse practitioner’s, and clinical nurse specialists’ services and services furnished incident to their professional services
§ 405.534 Limitation on payment for screening mammography services
§ 405.535 Special rule for nonparticipating physicians and suppliers furnishing screening mammography services before January 1, 2002

Terms Used In CFR > Title 42 > Chapter IV > Subchapter B > Part 405 > Subpart E - Criteria for Determining Reasonable Charges

  • Beneficiary: A person who is entitled to receive the benefits or proceeds of a will, trust, insurance policy, retirement plan, annuity, or other contract. Source: OCC
  • Charity: An agency, institution, or organization in existence and operating for the benefit of an indefinite number of persons and conducted for educational, religious, scientific, medical, or other beneficent purposes.
  • Contract: A legal written agreement that becomes binding when signed.
  • Equitable: Pertaining to civil suits in "equity" rather than in "law." In English legal history, the courts of "law" could order the payment of damages and could afford no other remedy. See damages. A separate court of "equity" could order someone to do something or to cease to do something. See, e.g., injunction. In American jurisprudence, the federal courts have both legal and equitable power, but the distinction is still an important one. For example, a trial by jury is normally available in "law" cases but not in "equity" cases. Source: U.S. Courts
  • Evidence: Information presented in testimony or in documents that is used to persuade the fact finder (judge or jury) to decide the case for one side or the other.
  • Fiscal year: The fiscal year is the accounting period for the government. For the federal government, this begins on October 1 and ends on September 30. The fiscal year is designated by the calendar year in which it ends; for example, fiscal year 2006 begins on October 1, 2005 and ends on September 30, 2006.
  • Jurisdiction: (1) The legal authority of a court to hear and decide a case. Concurrent jurisdiction exists when two courts have simultaneous responsibility for the same case. (2) The geographic area over which the court has authority to decide cases.
  • Markup: The process by which congressional committees and subcommittees debate, amend, and rewrite proposed legislation.