Code of Federal Regulations > Title 42 > Chapter IV > Part 405 > Subpart E - Subpart E—Criteria for Determining Reasonable Charges

U.S. Code of Federal Regulations

Regulations most recently checked for updates: Aug 27, 2025

§ 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.