Commonwealth Consolidated Acts Commonwealth Consolidated Acts(1) A medicare benefit payable in respect of a professional service shall not exceed the medical expenses incurred in respect of the professional service.
(2) Subsection (1) does not apply if:
(a) the rendering of the professional service is covered by an agreement between a private health insurer and another person; and
(b) the amount payable under the agreement for the professional service is not determined on a fee for service basis.