A payer can never pay more than your billed charge. Select your most-used CPT codes, enter your current billed charge and weekly volume — see exactly how your fee schedule compares to the Medicare benchmark and what it's costing you annually.
How to use this tool: Select a CPT code from the dropdown — the 2026 Medicare rate fills automatically. Enter your current billed charge and average weekly visit volume for that code. Add as many codes as you need, or calculate with just one. Industry standard is 200–250% of Medicare. If you're below that range, payers are capped at your lower charge on every claim.
CPT CodeMedicare RateYour Billed ChargeWeekly VisitsAnnual Gap
⚠ Significant Revenue Gap Identified
Your fee schedule is leaving significant revenue on the table.
One or more of your billed charges are below 150% of Medicare. Payers who would have paid more are capped at your lower billed charge on every single claim — and that revenue is gone permanently.
The fix is straightforward — but it has to happen before your next claim batch.
The Fee Schedule Optimization Playbook walks you through the Medicare benchmark methodology, how to set the right multiplier for your specialty and market, and exactly how to update your charge master without disrupting active claims.
Your fee schedule is in range but not fully optimized.
Your billed charges are between 150–200% of Medicare. You're within range, but below the 200–250% benchmark that maximizes collections from payers who would pay more.
Close the gap before your next contract renewal.
The Fee Schedule Optimization Playbook covers the complete benchmarking and update methodology — including how to adjust charges without triggering payer audits and how to time updates around contract cycles.
Your billed charges are at or above the benchmark.
Your fee schedule is set at 200%+ of Medicare across the codes you entered. Payers are not being artificially capped by your billed charges — the ceiling is where it should be.
Fee schedule is solid. What about your contracted rates?
A well-set fee schedule is the ceiling — but what payers actually pay depends on your contracted rates. If your contracted rates are below market, the ceiling doesn't matter.