If Joe's anesthesiologist charged $1500 and the Medicare fee schedule shows a maximum allowable amount of $1300, how much will Medicare Part B pay if it is his first claim in a year where the deductible is $150?

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In determining how much Medicare Part B will pay in this scenario, it is important to consider both the deductible and the maximum allowable amount set by the Medicare fee schedule.

Joe's anesthesiologist charged $1500 for the service, but Medicare's maximum allowable amount is $1300. Medicare will only pay benefits based on the allowable amount, not the charged amount. First, we must account for the deductible of $150 since this is Joe's first claim of the year.

To calculate the payment, we start with the allowable amount of $1300. Since Joe has not yet met his deductible, the first $150 will be subtracted from this amount:

$1300 (maximum allowable) - $150 (deductible) = $1150.

Medicare typically pays 80% of the amount after the deductible is met. In this case, 80% of $1150 is calculated as follows:

0.80 x $1150 = $920.

This is the amount that Medicare will pay for this claim. Thus, Medicare Part B will reimburse $920 towards Joe's anesthesiologist's charge after factoring in the deductible. Therefore, the correct amount Medicare will cover is $920.

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