How does your contract compare with Medicare?
Paste the codes and allowed amounts from one payer contract or fee schedule. Each code is matched against the CY2026 Medicare Physician Fee Schedule and shown as a percent of Medicare, with the codes paid below Medicare flagged and the yearly value of a better rate. Everything runs in your browser; your file is never uploaded.
1. Your contract rates
One code per line: code, allowed amount, yearly volume (volume is optional but makes the summary much more useful). Commas, tabs or semicolons all work. A header row is fine. Up to 200 codes.
Allowed amount means what the plan agreed to pay in total (plan payment plus patient share), not the billed charge and not the plan's share alone.
2. Your target
Typical commercial rates by specialty
Independent practices usually land in these ranges, measured as a percent of the Medicare national amount. They are starting points from published surveys and our own contract reviews, not promises. Your market, your payer mix and how many patients you bring the plan all move the number.
A contract under 100 percent of Medicare is worth a conversation with the payer. One under 80 percent is usually worth a formal renegotiation request with this table attached.
Mostly E/M codes with thin margins. Below 100 percent of Medicare is common for new practices and small groups; well-negotiated contracts reach 115 to 130 percent. Pediatric contracts often key off a non-Medicare fee schedule because Medicare does not price well-child visits.
Historically paid below other specialties. Parity laws are pushing rates up, so a contract under 100 percent is worth renegotiating with recent utilization data.
Timed codes with visit limits. Payers often use a flat per-visit case rate instead of a percent of Medicare; convert the case rate using your average units per visit before comparing.
Procedure-heavy specialties with hospital leverage. Office E/M often sits near 110 percent while procedures run higher; check the two groups separately.
Surgical specialties negotiate the widest spread. Rates above 150 percent are typical in markets with few surgeons and for ASC-based groups.
Destruction, biopsy and excision codes carry most of the revenue. Watch for payer edits that bundle lesion counts even when the rate looks strong.
Global obstetric packages are priced as a lump sum; convert them to the 59400 or 59510 Medicare amount before comparing. Office gynecology sits closer to primary care rates.
Often a flat case rate per visit (S9083). Compare the case rate against your average E/M level plus the procedures you actually perform.
System contracts carry facility leverage that an independent practice does not have. Do not use these as your target; use the independent ranges above.
How we calculate this
Every number on this page comes from your rows and the Medicare table. Nothing is estimated except where we say so.
- Matching. Each code is cleaned (uppercase, modifiers removed) and looked up in our table of 462 common office codes (81 of them lab codes on the Clinical Laboratory Fee Schedule). Codes we do not carry are listed separately and left out of the totals.
- Percent of Medicare = your allowed amount ÷ the Medicare national non-facility amount × 100. Medicare amounts are total RVUs × the CY2026 conversion factor of $33.4009; lab codes use the CLFS national amount.
- Volume-weighted average = sum of (your allowed × volume) ÷ sum of (Medicare allowed × volume). Codes without a volume count once. This is the number to quote in a negotiation, because it reflects what you actually bill.
- Annual impact = sum over matched codes of (target percent × Medicare allowed − your allowed) × volume. Codes already above the target count as negative (they would come down under a flat percent-of-Medicare contract), so the impact is the net change.
- What is left out. Locality adjustment (GPCI), which moves Medicare amounts roughly 5 to 15 percent in either direction; the 2 percent sequester; facility (hospital) rates; multiple-procedure reductions; and payer edits. Preventive visit codes that Medicare does not pay (99381 to 99397) are shown at their RVU value as a reference only.
Sources: CMS CY2026 Physician Fee Schedule final rule and national RVU file; CMS Clinical Laboratory Fee Schedule. Anchor codes were checked against published national amounts; the rest are computed from RVUs and should be treated as national averages. Found an amount that looks off? Tell us and we will correct it.
Want help with the renegotiation?
Revelrex reviews payer contracts, checks that payers actually pay the contracted rate on every remittance, and prepares the data package for the rate conversation. Book a 30-minute call and bring this benchmark.