Medicare Part B
The medical insurance part of Medicare, covering physician services, outpatient care, durable medical equipment, and preventive services.
1 min read · Last reviewed May 23, 2026
At a glance
- Category
- Payer
- Primary sources
- 1
- Workspace handoff
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Where this comes up
Front-office and billing both hit this term — eligibility before the visit, prior auth before the procedure, contract terms during fee-schedule negotiation, and credentialing whenever a new provider joins or a payer roster lapses. Misses here become denials downstream.
Full definition
What it is in practice
CMS Medicare Part B pays physician services under the PFS. Beneficiaries pay an income-adjusted premium plus 20% coinsurance on most services after the annual deductible.
How it shows up in your practice
Most outpatient physician practice revenue runs through Part B. Coordination with Medigap supplements typically eliminates the 20% balance for the patient.
Sources
- CMS — Physician Fee Schedulehttps://www.cms.gov/medicare/payment/fee-schedules/physician
Look up Medicare Part B rules in Ask D3
Open ask d3 →Related terms
- PayerMedicare Part AThe hospital insurance part of Medicare, covering inpatient hospital, skilled nursing facility, hospice, and limited home health.
- BillingPhysician Fee Schedule (PFS)The CMS Medicare reimbursement schedule for physician and certain non-physician practitioner services, published annually.
- Denials & AppealsABN (Advance Beneficiary Notice of Non-coverage)A standardized notice (CMS-R-131) given to Medicare fee-for-service beneficiaries before furnishing a service Medicare may not cover.
- PayerMedigapStandardized Medicare supplemental insurance policies (Plans A through N) that pay some of the costs Original Medicare does not.
D3rx is a healthcare-billing and compliance research aid maintained by D3rx Inc. Articles are drafted by an LLM (Anthropic Claude) against primary HHS, OCR, CMS, eCFR, NIST, and state-regulator publications, and reviewed for restraint and source fidelity by the D3rx team.
Reviewer status: a named credentialed reviewer (CHC, CHPC, or healthcare attorney) is being engaged. Until that engagement is finalized, this page does not claim credentialed review.
Related across the archive
- GlossaryMedigapStandardized Medicare supplemental insurance policies (Plans A through N) that pay some of the costs Original Medicare does not.
- GlossaryPhysician Fee Schedule (PFS)The CMS Medicare reimbursement schedule for physician and certain non-physician practitioner services, published annually.
- GlossaryMedicare Part AThe hospital insurance part of Medicare, covering inpatient hospital, skilled nursing facility, hospice, and limited home health.
- GlossaryABN (Advance Beneficiary Notice of Non-coverage)A standardized notice (CMS-R-131) given to Medicare fee-for-service beneficiaries before furnishing a service Medicare may not cover.
- GlossaryCardiac Stress Test (93015-93018)CPT codes for cardiac stress testing, with separate codes for the global service, supervision, and interpretation.
- GlossaryCharge CaptureThe process of identifying and recording every billable service furnished during a patient encounter.
- ComplianceOIG LEIE Monthly Exclusion Screening: Process + Audit-Ready LogsMonthly OIG LEIE and SAM.gov exclusion screening for every workforce member and vendor: the workflow, the log fields auditors require, and the escalation path.
- RegulationMLN: 'Incident To' Services in Medicare Part BReference to Medicare's incident-to billing rules permitting auxiliary personnel to furnish services billed under the physician's NPI, with strict supervision and treatment-plan requirements.
This glossary entry is a research aid for billing and compliance staff. It does not provide legal, medical, or financial advice and does not replace counsel. References cited link to primary sources at HHS, OCR, CMS, eCFR, NIST, and the relevant payer or industry body.