allowable charge

allowable charge

[əlou′əbəl]
the maximum dollar amount that a third party, usually an insurance company, will reimburse a provider for a specific service.

allowable charge

Managed care The lesser of the actual charge, the customary charge and the prevailing charge, which is the amount on which Medicare bases Part B payments

al·low·a·ble charge

(ă-lowă-bĕl chahrj)
Maximum payment amount to a provider per terms of a patient's policy.
References in periodicals archive ?
Nonparticipating physicians could only charge a bit over the Medicare 'maximum allowable charge.
Routing is also a key consideration, to avoid routing refrigerant piping through smaller enclosed rooms with a lower maximum allowable charge.
For non-network providers, the outpatient cost-share is 20 percent of the Tricare allowable charge, and the inpatient cost-share is $16.
However, the blanket imposition of the maximum allowable charge will worry every family - and there will be many - for whom it represents a life-altering obligation.
If you bill the patient more than the maximum allowable charge under Medicare, you lose your license," said Dr.
Family members who use the point-of-service option are responsible for paying the annual deductible of $300 per member or $600 per family, and 50 percent of the TRICARE allowable charge once the deductible is met.
In most cases, the charge was far less than the maximum allowable charge, she said.
Once the deductible is met, the cost for additional POS care will be 50% of the CHAMPUS/TRICARE allowable charge.
If a medical-care provider does not participate in CHAMPUS but bills more than the allowable charge, a participant is responsible for this amount as well.