Medicare pays 80 percent of the fee schedule amount for a physician's service. For a Medicare-covered service provided by a participating physician, the beneficiary is responsible for 20 percent of the fee schedule amount. A nonparticipating physician, however, may charge up to 115 percent of the Medicare fee schedule amount, with the beneficiary thus being responsible for a greater portion of the total fee. Participation includes several advantages for the provider. The Medicare fee schedule is 5 percent higher than for nonparticipants.
Participants can use toll-free lines to submit claims electronically.