Defensible Fee Schedule Toolkit

Establishing cost based practice fee schedules

The AMA has developed the educational resource “Fee schedule analysis: Using your complete practice cost as a guide”  (PDF, 97KB) to help physicians and their practice staff recognize the need to establish their practice fee schedule based on what it actually costs to provide a service rather than basing their fee schedule on what a third-party payer or other entity decides is fair payment. This resource includes a 12-step guide to help physician practices create their own unique physician practice fee schedule with an easy-to-complete spread sheet.

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Fee schedule analysis: Using your complete practice cost as a guide  (PDF, 97KB)

Hypothetical physician practice fee schedule  (PDF, 39KB)

Interactive fee schedule  (Excel, 26KB)

It is important that physicians understand how a fee schedule can affect their practice’s bottom line so that they can make informed decisions about participation in a health plan before contracts are signed. CMA has developed a simple worksheet to help physicians analyze proposed fee schedules and assess the impact fee schedule changes may have on physician practices based on commonly billed CPT codes.