Fee Schedule

A fee schedule is the list of contracted rates a payer agrees to pay you per code — the benchmark that turns a payment into a verifiable number and exposes underpayments.

A fee schedule is the table of dollar amounts a payer has agreed to pay you for each procedure code, place of service, and (sometimes) modifier under your contract. It's the reference that makes 'were we paid correctly?' an answerable question: without your loaded fee schedule, an allowed amount is just a number the payer asserts; with it, you can compare what the payer allowed to what it promised. Fee schedules are where a lot of quiet revenue leakage lives. Payers price claims off the fee schedule loaded in their system, and that copy can be outdated, mis-loaded, or a renegotiated rate that wasn't applied by its effective date — each of which produces an allowed amount below your contracted rate that shows up as a normal-looking contractual adjustment. There's no flag on the remit that says 'we underpaid you'; the only way to catch it is to compare the allowed amount on every line to your fee schedule. Many practices don't have their contracted rates loaded in a form they can check against, which is exactly why below-fee-schedule underpayments are the most-missed recoverable dollars — they require a benchmark the practice often doesn't have at hand.

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