Free Excel template · Medical Billing

Fee Schedule Review Worksheet

Pressure-test your charge master against Medicare and your top payer. Enter your fee, the Medicare allowable, and your top payer's allowed amount per CPT code; the worksheet computes your fee as a % of Medicare, the variance against your payer, and flags codes that are likely underpriced — money you may be leaving on the table at every visit. Start on the Instructions tab.

✓ Instructions
✓ Fee Review
✓ Summary

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Excel template · FreeFee Schedule Review Worksheet

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Spotsaas · 2026

Fee Schedule Review Worksheet

✓ Instructions

✓ Fee Review

✓ Summary

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What it is

The Fee Schedule Review Worksheet is a downloadable Excel workbook that pressure-tests a practice's charge master against Medicare and its top payer. For each CPT code, the user enters their current fee, the Medicare allowable, and their top payer's allowed amount; the worksheet computes the fee as a percentage of Medicare, the variance against the payer, and flags codes that are likely underpriced — money the practice may be leaving on the table at every visit. Its core warning is simple: your billed fee should sit comfortably above every payer's allowed amount, because if you bill below what a payer would pay, you're capped at your own fee and lose the difference.

The workbook spans three tabs. The Instructions tab explains the logic — a common rule of thumb is to set fees at a consistent multiple of the Medicare allowable, often 200-300% — and defines the key terms: percent of Medicare (your fee ÷ Medicare allowable), variance versus top payer (your fee − top payer allowed, which should be positive), and the underpriced flag (triggered when your fee is at or below the payer allowed). The Fee Review tab is the working sheet, where entered fees and allowables drive automatic calculation of percent of Medicare, variance, and a flag of Underpriced, Review, or OK for each code. The Summary tab reports blended fee as a percentage of Medicare, counts underpriced codes, and returns a verdict against a target multiple.

The flag logic is explicit: a code is Underpriced if your fee is at or below the payer allowed, Review if it's under 150% of Medicare, and otherwise OK. The Summary's verdict escalates accordingly — urgent if blended fees are at or below the payer allowed (you're capping collections and should raise the schedule now), underpriced if fees sit below the target multiple of Medicare, or well-positioned if fees clear both the payer allowed and the target multiple. The workbook recommends reviewing annually and whenever Medicare RVUs or the conversion factor update, using your locality's current values from the CMS Physician Fee Schedule.

What it's used for

Practices use the worksheet to make sure their charge master isn't quietly capping collections by billing below what payers would pay. It converts an abstract worry — 'are our fees set right?' — into a code-by-code analysis with clear flags and a benchmarked verdict.

✓ Comparing each CPT code's billed fee against the Medicare allowable and the top payer's allowed amount to see exactly where fees sit relative to both benchmarks.
✓ Computing each fee as a percentage of Medicare so the schedule can be checked for consistency against a target multiple (commonly 200-300%).
✓ Flagging underpriced codes — where the fee is at or below the payer allowed — because billing below the payer's allowed amount caps collection at your own fee and forfeits the difference.
✓ Identifying 'Review' codes priced under 150% of Medicare that may warrant a raise, and confirming 'OK' codes that clear both benchmarks.
✓ Reporting a blended fee as a percentage of Medicare and a count of underpriced codes so the practice sees its overall positioning, not just code-by-code detail.
✓ Returning a clear verdict — urgent, underpriced, or well-positioned — that tells the practice whether to raise the schedule now, review flagged codes, or simply re-check after the next Medicare update.
✓ Setting a disciplined review cadence — annually and whenever Medicare RVUs or the conversion factor change — using current locality values from the CMS Physician Fee Schedule.

Who uses it

The worksheet is used by the people responsible for setting and maintaining the charge master and the financial leaders who own collections. It bridges the technical fee-schedule work and the management decision to raise prices.

Practice managers and administratorsThey own the charge master and use the worksheet to confirm fees aren't capping collections, then act on the verdict to raise underpriced codes.

Revenue cycle managersThey connect fee-schedule positioning to collections and use the blended percentage of Medicare and underpriced-code count to prioritize which codes to adjust.

Billing managers and charge-master analystsThey maintain the code-level fees and use the Review and Underpriced flags to know exactly which CPT codes need attention after each Medicare update.

Practice owners and physiciansThey care about whether the practice is being paid what its contracts allow, and the verdict gives them a clear, non-technical read on whether the fee schedule is leaving money behind.

Healthcare financial consultantsConsultants advising practices on revenue use the worksheet's benchmark logic and target-multiple comparison to make a data-backed case for repricing the charge master.

Context & good to know

The charge master is a quietly powerful lever in the revenue cycle because it sets a ceiling on collection: a payer pays the lesser of your billed fee and its allowed amount, so any code priced below the payer's allowable forfeits the difference on every single claim. Unlike a denial, this loss is invisible and recurring — the claim pays, just for less than it could have. The worksheet exists to surface that hidden ceiling, because most practices have at least a few codes priced below what a payer would happily pay.

Fee-setting is conventionally anchored to the Medicare allowable because Medicare's Physician Fee Schedule is a stable, transparent benchmark that updates predictably with RVU and conversion-factor changes. The common consultant rule of thumb — setting fees at 200-300% of the Medicare allowable — gives a practice a consistent, defensible structure rather than a patchwork of legacy prices. The worksheet's percent-of-Medicare and target-multiple logic operationalizes that approach, flagging codes that fall out of the desired band so the schedule stays coherent and competitive across every payer the practice bills.

On Spotsaas, fee-schedule management and contract-rate analytics are features that distinguish more sophisticated billing and practice-management platforms — some can compare billed fees against contracted rates and surface underpriced codes automatically, exactly as this worksheet does manually. The worksheet pairs naturally with the Days-in-A/R tracker and the Charge Capture Audit Checklist, since correct pricing only matters once the charge is captured and the claim is collected promptly. Practices comparing software on Spotsaas should weigh whether a platform offers fee-schedule and contract-rate tooling, because a charge master that's reviewed annually against Medicare and payer allowables is one of the simplest ways to protect revenue without seeing a single additional patient.

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FAQ

Questions, answered

Why does my billed fee need to be higher than the payer's allowed amount?

Because a payer pays the lesser of your billed fee and its allowed amount. If you bill below what the payer would pay, you're capped at your own fee and lose the difference on every claim for that code. Setting fees comfortably above every payer's allowed amount ensures you collect the full contracted rate rather than artificially limiting yourself. The worksheet flags any code where your fee is at or below the payer allowed as Underpriced.

What does 'percent of Medicare' mean for fee setting?

Percent of Medicare is your fee divided by the Medicare allowable for that code. It's a way to keep your fee schedule consistent — a common consultant rule of thumb sets fees at 200-300% of the Medicare allowable. Because Medicare's Physician Fee Schedule is a stable, transparent benchmark, anchoring your fees to a consistent multiple of it gives the charge master a coherent structure instead of a patchwork of legacy prices.

How does the worksheet flag underpriced codes?

The flag logic is explicit: a code is Underpriced if your fee is at or below the top payer's allowed amount (you're capping your own collection), Review if your fee is under 150% of Medicare (it may warrant a raise), and otherwise OK. The Fee Review tab applies this automatically as you enter your fee, the Medicare allowable, and the payer allowed, so you can immediately see which codes need attention.

How often should I review my fee schedule?

Annually at minimum, and whenever Medicare RVUs or the conversion factor update, since those changes shift the Medicare allowable your fees are benchmarked against. Reviewing on this cadence keeps the schedule current and prevents codes from drifting below payer allowables as rates change. The worksheet is designed to be re-run each cycle against your locality's current CMS Physician Fee Schedule values.

Where do I get the Medicare allowable amounts?

From the CMS Physician Fee Schedule for your specific locality — allowables vary by geographic area. The sample values in the worksheet are illustrative placeholders, and the instructions explicitly direct you to replace them with your locality's current values before acting on the results. Using the wrong locality's numbers would distort your percent-of-Medicare calculations and the resulting flags.

Is raising fees the same as getting paid more?

Not exactly — raising a fee above the payer's allowed amount doesn't increase what a contracted payer pays for that code, because they still pay their allowable. What it does is stop you from capping collection below the allowable. The real gain comes from finding codes where your fee sits below the payer allowed and raising them to capture the full contracted rate. For self-pay and out-of-network situations, the billed fee matters more directly.

What is the verdict on the Summary tab telling me?

The Summary returns a recommendation based on your blended fees: 'urgent' if blended fees are at or below the payer allowed (you're capping collections and should raise the schedule now), 'underpriced' if fees sit below your target multiple of Medicare (review the flagged codes for a raise), or 'well-positioned' if fees clear both the payer allowed and your target multiple (re-check after the next Medicare update). It translates the code-level detail into a single clear action.

Should every code be set at the same percentage of Medicare?

The rule of thumb favors a consistent multiple across the schedule for coherence, but the practical floor is that every fee must clear every contracted payer's allowed amount. Some codes — particularly low-RVU items like venipuncture or ECG — have Medicare allowables so low that a strict multiple would still leave the fee below a commercial payer's allowed amount, so those need to be set above the payer allowed regardless of the multiple. The worksheet's underpriced flag catches exactly those cases.

Can I create my own fee schedule, or do I need software?

You can build and review a fee schedule with a worksheet like this one — entering your fees, Medicare allowables, and payer allowables to find underpriced codes. Software helps at scale: practice-management and billing platforms can store the charge master, compare billed fees against contracted rates, and surface underpriced codes automatically. The worksheet is ideal for a focused annual review; software is better for ongoing, code-by-code monitoring across many payers.

Which billing software helps manage fee schedules?

More sophisticated billing and practice-management platforms include fee-schedule management and contract-rate analytics — they can hold your charge master, compare your billed fees against each payer's contracted rate, and flag underpriced codes the way this worksheet does manually. When comparing options on Spotsaas, whether a platform offers fee-schedule and contract-rate tooling is a useful differentiator, since regular charge-master review is one of the simplest ways to protect revenue.

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