What Can You Charge TRICARE Patients?

Q. I have a new patient who receives her care through TRICARE, the health benefit program that serves members of the uniformed services and their families. I have opted out of Medicare and do not have any relationship with TRICARE. I would like to have a private contract with her and charge her my standard fee, but she has informed me that I am permitted to charge her only up to the Medicare limiting fee. Is this correct?

A. Yes, this is correct. If you see a patient covered by TRICARE, regardless of whether you have a relationship with TRICARE or your Medicare provider status, the only way you would be permitted to charge more than the Medicare limiting fee (which can be found in the online Medicare physician fee schedule for your location) is if the patient requested a waiver so that a higher fee could be levied by the physician.