UCR Fees

Usual, customary and reasonable charges (UCR) are medical fees used when there are no contractual pricing agreements and used by certain healthcare plans and third-party payers to generate fair healthcare pricing. 

Where does Find-A-Code get their data for UCR?

Find-A-Code offers UCR fees gathered from the US Department of Veterans Administration (VA) using Geographically-adjusted charges and the 80th percentile conversion factors; this information can be found on the code information page (see example below) and is offered as a fee comparison with our UCR Pricing add-on.

Where are UCR fees located in Find-A-Code?

While on the code information page scroll down to the fees section and open the tab titled “UCR Fees”, the fees will be displayed for UCR, Workers Comp, as well as Medicare Billed and Allowed.

UCR for CPT/HCPCS Code:

UCR for DRG Codes:

What information comes from the VA? 

The following information comes from the VA to give an understanding of accountability to the Federal Register, calculations and links to data sources used on our UCR pricing.  

Reasonable charges according to the VA is described as follows; Reasonable Charges are based on amounts that third parties pay for the same services furnished by private-sector health care providers in the same geographic area. In the past, VA used average cost-based, per diem rates for billing insurers. Reasonable charges are calculated for inpatient and outpatient facility charges, and for professional or clinician charges for inpatient and outpatient care.

Reasonable Charges Rules, Notices, & Federal Register

The VA determines the amount of the national average administrative cost annually for the prior fiscal year (October through September) and then applies the charge at the start of the next calendar year. Below are links to the Federal Register and data sources from the VA Website.

Inpatient:

Outpatient and Professional

Federal Register / Vol. 84, No. 189 / Monday, September 30, 2019 / Notices 

Find-A-Code's Tools & Resources

Pro-Fee Calculator

Verify Medicare Reimbursement and UCR Fees for Professional Services

Unlimited Fee Reports

Compare your fees with Medicare, OWCP, VA's UCR

Webinar- The Importance of Fee Schedules

The importance of gathering organizing and using fee schedules

UCR Pricing, What is it?

Read this short article on what UCR is and where it comes from

Additional Links and Resources

Inpatient/SNF

REASONABLE CHARGES DATA SOURCES — v3.26

OPT/Phys/Anes/Lab/DME

REASONABLE CHARGES DATA SOURCES — v3.25 (January - December 2019) - Sorted By Charge Type

Select the title to see a summary and a link to the full article.

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Check out the information page on any DRG! Look up DRGs by going to the list of DRG codes found under the Codes tab at the top of the page, or simply type in the desired DRG by using the search bar on the homepage. When using the search bar, be sure you have the ...

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How does the VA determine charges billed to third party payers for Veterans with private health insurance? According to the VA. "38 C.F.R 17.101 stipulates the basic methodology by which VA bills third party insurance carriers. In order to generate a charge for medical services, VA establishes reasonable charges for five ...

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Find-A-Code offers fees and pricing for just about everything, this article will address two of some of the most common payment systems with CMS. (OPPS) -Outpatient Medicare Outpatient Prospective Payment System. (MPFS)- Medicare Physician Fee Schedule The Fees section on each code page is determined on the type of services...

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VA- Reasonable Charges Rules, Notices, & Federal Register

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So How Do I Get Paid for This? APC, OPPS, IPPS, DRG?

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You know how to find a procedure code and you may even know how to do the procedure, but where does the reimbursement come from?  It seems to be a mystery to many of us, so let's clear up some common confusion and review some of the main reimbursement systems.  One of the ...

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