A comprehensive listing of fees used by a health care plan to reimburse physicians and/or other providers on a fee-for-service basis. Back to the top of the page

A list of certain services and payable amounts indicating the maximum Medicare payment for the service. Method of payment is calculated by the Resource Base Relative Value Unit Scale by which Medicare reimburses physician and nonphysician services. Fee schedules are sent to providers in the fall.

A listing of established allowances for specific procedures. It usually represents either standard or maximum amounts the insurer pays.

Allowable amounts established by the Department of Economic Security for medical, dental, and psychological care for foster children.

A listing of the maximum fee that a health plan will pay for a certain service based on CPT billing codes. (Also referred to as Fee Maximums or as a Fee Allowance Schedule.)

A list of the charges for specific services to which a provider agrees.

a complete listing of fees used by Medicare to pay doctors or other providers/suppliers

A list of amounts allowed for specific services.

A fee Schedule is an explicitly noted schedule used by the carrier to determine the eligible amount charged. In stop loss, the RBRVS charge master is used for re-pricing physician fees, and the Reasonable & Customary schedule is typically used in pricing the hospital reimbursement. The fee schedule used dramatically effects eligible and reimbursable charges.

The fee determined by an MCO to be acceptable for a procedure or service, which the physician agrees to accept as payment in full. Also known as a fee allowance, fee maximum, or capped fee.

A schedule that a plan follows for payment (e.g. for dental procedures).

11 The fee determined by a Managed Care Organization to be acceptable for a procedure or service, which the physician agrees to accept as payment in full.

An established rate which a provider will be reimbursed for services rendered, also referred to as maximum allowable.

A benefit payment system where a health plan or managed care company determines the fees that are acceptable for procedures or services, and the network physicians agree to accept these fees as full payment.

A listing of fees or allowances for specific procedures which usually represents the maximum amount the program will pay for specific procedures.

Maximum dollar or unit allowance for health services that apply under a specific contract.

A list of the charges established or agreed to by a dentist for specific dental services.

A list of amounts to be paid for specific services or procedures by participating providers as stated in the WellChoice participating provider contract.

Schedule or list of maximum benefits that will pay under a group medical contract for certain listed procedures.

A list of set payment amounts for specific medical services. Both providers and insurers can set fee schedules.

A list of medical procedures and associated maximum payments.

A list of the charges for specific dental procedures established or agreed to by a dentist.

The Fee Schedule appears in a supplement to these Rules.

A complete listing of fees used by health plans to pay doctors or other providers.

Shows the maximum a plan will pay for specified medical procedures.

A list of accepted fees or predetermined monetary allowances for specified services and procedures.

A listing of the maximum fee which a health plan will pay for services based on CPT billing codes.

Also called "Medicare allowable"; the amount Medicare defines as usual and customary for payment. Medicare Part B reimburses at 80% of the fee schedule. The beneficiary is responsible for 20%. In non-Medicare situations, it appears to WHI's price list.

A pre-determined fee corresponding to CPT Codes that a provider is to be reimbursed by a healthcare insurer for patient services rendered. The provider agrees to accept this as payment in full. Also called “fee allowances” or “maximum allowable.

A listing of accepted charges or established allowances for specified medical, dental, or other procedures or services. It usually represents either a physician's or third party's standard or maximum charges for the listed procedures.

A listing of accepted fees or established allowances for specified medical procedures. As used in medical care plans, it usually represents the maximum amounts the program will pay for the specified procedures.

A payment structure used by the insurance company that places caps or limits on the dollar amounts that it will reimburse your providers for the covered medical services and procedures, both in and out-of-network if applicable.

(1) A schedule of fees; (2) Predetermined fees paid be the insurance company regardless of what the dentist charges.