Fee schedule

A fee schedule is the specific list of dollar amounts a given insurance plan will pay for each procedure code, and every PPO contract a practice signs comes with one attached. It is the document that actually determines a plan's profitability, far more than the plan's name or reputation: two PPOs from the same carrier in different markets, or even different fee schedule tiers from the same carrier, can pay meaningfully different amounts for the identical procedure.

Comparing a plan's fee schedule against your own full fee, procedure by procedure on your ten or twenty highest-volume codes, is the single most useful exercise before deciding whether to sign, renegotiate, or drop a contract. A plan that looks acceptable on its headline reimbursement for an exam can still be a poor payer on the crowns and root canals that actually drive a practice's revenue, and the reverse is also true.

Fee schedules are also renegotiable more often than owners assume: carriers periodically update them, and a practice that has grown its reputation, patient volume, or specialty mix has real leverage to request a review rather than accepting whatever schedule was signed years earlier.