OB/GYN Fee Schedule Optimization

The revenue you don't see

Most revenue problems announce themselves: a denial arrives, an A/R report turns red. Fee schedule problems don't. They hide inside claims that look "paid."

Here are three ways OB/GYN practices commonly lose money without a single denial:

1. Charges set below allowed amounts. A practice sets its fee for a common code years ago and never updates it. A payer's allowed amount rises above that charge. Because most payers pay the lesser of billed charges or the allowed amount, the practice is now capped at its own outdated fee.
2. Silent underpayments. A payer pays a claim at less than the contracted rate — because of a loading error, a wrong fee schedule year, or an incorrectly applied multiple-procedure reduction. The remit says "paid," so nobody checks.
3. Contracts that haven't kept up. A contract signed five years ago may pay well below what the same payer pays other practices in your area, and well below what your highest-volume services cost to deliver.

With more than eight years of billing for OB/GYN practices, we've learned that fee schedule work is some of the highest-value analysis a practice can do — because it improves payment on every claim going forward.

What our fee schedule service includes

1. Fee schedule (chargemaster) review

We pull your current charges and compare them, code by code, against your payers' allowed amounts and Medicare's physician fee schedule for your locality. Any code where your charge falls below what a payer would allow is flagged. We recommend a consistent, defensible method for setting charges — often a multiple of Medicare — so your fee schedule is easy to maintain.

2. Payer contract analysis

For your highest-volume and highest-value codes — prenatal and delivery services, office E/M, preventive visits, ultrasounds, LARC procedures and common surgeries — we compare what each payer pays. You'll see which contracts are strongest, which are weakest, and where a renegotiation would matter most.

3. Underpayment detection and recovery

Expected reimbursement is loaded for each payer and compared to every payment. Variances are reviewed, and legitimate underpayments are appealed. We also check that multiple-procedure reductions, bilateral rules and modifier-based reductions were applied correctly — a frequent source of underpayment on surgical claims.

4. Payer mix and profitability view

We summarize collections by payer and service line so you can see where your revenue actually comes from — and which payers are costing more to work with than they pay.

OB/GYN codes we focus on

Getting contracts ready for 2027

The AMA's CPT 2027 code set deletes the global maternity package codes for dates of service on or after January 1, 2027, replacing them with E/M-based prenatal and postpartum visits, new labor management codes and new delivery codes. Contracts that list rates for 59400, 59510 and related codes will need to address how the new codes are paid. Practices that wait until January may find themselves paid under default methodologies they never agreed to. Our 2027 maternity transition guide explains the change; we can help you model what your current OB volume would look like under the new structure.

How a fee schedule project works

1. Data collection. Current fee schedule, payer contracts (or rate sheets), and 6–12 months of claim and payment data.
2. Benchmarking. Charges compared to allowed amounts and Medicare locality rates.
3. Contract comparison. Rates for top codes compared across payers.
4. Underpayment scan. Payments compared to expected amounts.
5. Report and recommendations. Fee schedule updates, recoverable underpayments, and contracts to prioritize for renegotiation.
6. Ongoing monitoring. For clients on our revenue cycle management service, payment variance checks continue every month.

An honest note on expectations

We won't promise a specific revenue increase from fee schedule work. The impact depends entirely on how your current fees compare to payer allowables, how your contracts are written, and how much negotiating leverage your practice has. What we will do is show you the numbers clearly so you can make informed decisions.

Understanding how payers calculate what they pay

Most commercial OB/GYN contracts use one of a few methods to set allowed amounts, and knowing which one applies to each contract is the first step in spotting underpayments:

• Percentage of Medicare. The allowed amount is a percentage (for example, 120% or 140%) of the Medicare Physician Fee Schedule for your locality — sometimes for a specific year, sometimes "current year." A contract tied to an old Medicare year can lose value every year.
• Proprietary fee schedule. The payer publishes its own rates, which may or may not be updated annually. These schedules can be hard to obtain; we request them as part of the analysis.
• Percentage of billed charges. Less common for professional services, but it makes your own charge levels directly decide what you're paid.
• Case rates and packages. Some plans pay obstetric care, fertility cycles or certain surgeries as a fixed case rate.

Medicare itself sets payment through relative value units (RVUs) — work, practice expense and malpractice — multiplied by a geographic adjustment and the annual conversion factor. That framework is the basis for most commercial benchmarking, which is why we use your Medicare locality rates as the starting point.

Signs your fee schedule needs attention

• Your charges haven't been updated in more than two years
• Payments for a code exactly equal your billed charge (a sign the charge is below the allowed amount)
• Different payers pay wildly different amounts for your top codes
• You don't have copies of current rate sheets for your largest payers
• Multiple-procedure surgical claims seem to be paid less than you'd expect
• Your contracts reference global OB codes and say nothing about how 2027 codes will be paid

If two or more of these sound familiar, a fee schedule review is likely to be worthwhile.

Get a free fee schedule check

Send us a WhatsApp message. We'll compare your charges for your top codes against Medicare and typical allowed amounts and review a sample of payments for underpayments — at no cost and with no obligation. You can also try our revenue leakage calculator for a quick estimate.