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Opinion 6.05 - Fees for Medical Services

A physician should not charge or collect an illegal or excessive fee. For example, an illegal fee occurs when a physician accepts an assignment as full payment for services rendered to a Medicare patient and then bills the patient for an additional amount. A fee is excessive when after a review of the facts a person knowledgeable as to current charges made by physicians would be left with a definite and firm conviction that the fee is in excess of a reasonable fee. Factors to be considered as guides in determining the reasonableness of a fee include the following:

(1) The difficulty and/or uniqueness of the services performed and the time, skill, and experience required

(2) The fee customarily charged in the locality for similar physician services

(3) The amount of the charges involved

(4) The quality of performance

(5) The experience, reputation, and ability of the physician in performing the kind of services involved (II)

Issued prior to April 1977; Updated June 1994