A practical approach to reviewing and optimizing your OB/GYN practice's fee schedule.
A fee schedule that hasn't been reviewed in years is quietly leaving money on the table, regardless of how accurate your coding is — because coding accuracy determines whether you bill the right code, while the fee schedule determines what you're actually asking to be paid for it.
Start With Your Highest-Volume Codes
Rather than reviewing every code your practice bills, start with the twenty or so codes that make up the bulk of your billed volume — global maternity billing codes, common office visit levels, and your most frequent GYN procedures. Small adjustments here have outsized impact simply due to volume.
Compare Against Regional Benchmarks
Fee schedules should reflect regional reimbursement patterns, not a static number carried forward from years ago or copied from a generic template. What's competitive in one region may significantly underbill in another.
Separate Fee Schedule From Contracted Rates
Your fee schedule (what you bill) and your contracted rate with a given payer (what you'll actually be paid) are different things, and confusing them leads to either unrealistic revenue expectations or a fee schedule set too low to matter for payers reimbursing at a percentage of billed charges.
Review Annually, Not Reactively
Waiting for a specific complaint or a noticeably low payment to trigger a fee schedule review means the practice has likely been underbilling for a long stretch already. An annual review, tied to the CPT code update cycle, keeps this from happening.
Key Takeaways
- ›Focus fee schedule review on your highest-volume codes first
- ›Benchmark against regional data, not historical inertia
- ›Review annually as a standing process, not just reactively
Our [fee schedule optimization](/fee-schedule-optimization) service pairs this review with actual [payer contract negotiation](/blog/negotiating-payer-contracts-obgyn) strategy, since the two work best addressed together rather than in isolation.