UCR Pricing, What is it?

by  Christine Woolstenhulme, QCC, QMCS, CPC, CMRS
January 25th, 2018

UCR (Usual, Customary, and Reasonable) pricing is a method of generating healthcare pricing based on the average pricing in a particular geographic location.  Gathering information on pricing based on what other providers in that area is charging is commonly used for a fee or payment reference, as it gives a basis on what is considered customary and reasonable.

If a provider is not contracted or in the absence of a contract, providers can set their fees and are entitled to a reasonable value for the service provided.  It is important to get your UCR data from a reliable source to arrive at a reasonable value. Find-A-Code offers UCR fees gathered from the VA or US Department of Veterans Administration; this information can be found on the code information page and is offered as a fee comparison with a fee analysis or the with Compare-A-Fee.