What percent of Medicare should my commercial rates be?
Commercial contracts are usually priced as a percentage of the Medicare fee schedule, and healthy commercial rates typically land well above 100% of Medicare — often in the ~110–160% range, varying widely by specialty, market, and leverage. Knowing where each payer sits against Medicare is the single most useful lens for spotting your worst contracts and prioritizing renegotiation.
What actually matters
- Express each payer's allowed amount by top CPT as a percentage of the current Medicare rate — that's the comparison that matters
- Commercial rates commonly run above 100% of Medicare; the exact healthy range depends on specialty and market
- Your lowest %-of-Medicare payers on your highest-volume codes are the first renegotiation targets
- Watch which Medicare year the contract pins to — an old base year silently erodes your rate as Medicare updates
- A rate that looks fine on paper is still an underpayment if the payer never loaded it
Common questions
Is 100% of Medicare a good commercial rate?
For most specialties and markets, commercial rates should exceed 100% of Medicare — often meaningfully. A commercial payer paying at or below Medicare is usually a weak contract worth renegotiating, though the healthy benchmark varies by specialty and region.
Where Volari fits: Percentage-of-Medicare tells you which contracts to renegotiate; Volari's line-by-line reconciliation tells you which claims the payer never paid at the rate you already agreed to.
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