Carve-Out

A carve-out is a group of services that are not covered under the primary contract, but are addressed under a separate agreement.  For instance, a practice may have a contract with a payer whereby the all services will be reimbursed to the practice at a specific percentage of Medicare.  There may also be a carve-out, whereby 10 procedures are paid at a contracted dollar rate, not a precentage of Medicare.