CMAA Practice Exam 2026 – Complete Guide for Exam Prep

The correct answer identifies the balance billing fee as a component that is not part of the Medicare fee schedule. In the context of Medicare, the fee schedule is a system that determines how much healthcare providers are paid for services rendered to Medicare beneficiaries.

The participating fee and nonparticipating fee represent the payments provider types receive for services under Medicare. Participating providers agree to accept Medicare's approved amount as payment in full, while nonparticipating providers can bill more than the Medicare allowed fee, although they must still adhere to certain limits. The limited charge pertains specifically to how much a nonparticipating provider can charge Medicare beneficiaries above the established fee schedule, setting a cap on additional costs.

In contrast, the balance billing fee generally refers to the practice of billing patients for the difference between what a provider charges and what Medicare pays, which can often lead to higher out-of-pocket costs for the patient. Since Medicare has specific rules about balance billing—particularly for participating providers—it does not fit into the structured payments defined in the Medicare fee schedule. Thus, balance billing fee is not a standardized component within the Medicare fee schedule framework.