Fee Schedule
A fee schedule is a complete list of the prices a payer or provider sets for each covered service or procedure code. ASC reimbursement hinges on contracted fee schedules, which determine the allowed amount paid per surgical CPT code.
What is a fee schedule?
A fee schedule is a defined list of the prices assigned to covered services and procedures, organized by the codes used to bill them. It may represent a provider's standard charges or, more importantly for reimbursement, the allowed amounts a payer has agreed to pay for each code.
Contracted fee schedules are negotiated between payers and providers and set the dollar figure that will be reimbursed when a particular code is billed and approved. Government programs publish their own schedules that providers must work within.
Why does the fee schedule matter for ASC reimbursement?
For an ambulatory surgery center, the contracted fee schedule largely determines revenue, since the allowed amount per surgical code is what the center can actually expect to collect from the payer. The relationship between those rates and the center's costs drives its margins.
Knowing the applicable fee schedule also makes it possible to detect underpayments, because remitted amounts can be checked against the contracted rate for each code. Without that reference, a center cannot tell whether it has been paid correctly.
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