As we head into the final stretch of the year, now is the ideal time to begin preparing your 2026 fee schedule. While fee setting often feels like an administrative chore, it plays a critical role in payer negotiations, patient communications, and overall financial sustainability. Fortunately, there is a methodical, defensible way to approach it.
Why Use Medicare as Your Benchmark?
One of the most widely accepted approaches to your practice fees is to establish your charges as a percentage of Medicare rates. This methodology—commonly referred to as the Resource-Based Relative Value Scale (RBRVS)—assigns relative values to CPT codes based on physician work, practice expense, and malpractice cost.
Using Medicare as a baseline offers several advantages:
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Consistency across services – Relative values ensure that fees scale appropriately between lower- and higher-complexity services
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Defensibility – Medicare’s methodology is transparent, standardized, and widely recognized by payers
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Simplicity – Setting a single percentage allows your entire fee schedule to update automatically
By selecting your practice’s Medicare locality and applying your chosen percentage, you can quickly generate a fee schedule that is both rational and easy to explain.
What About Vaccines and Lab Services?
Unlike professional services, vaccines and laboratory services do not have assigned RVUs, which often leaves practices guessing—or relying on outdated pricing assumptions.
That’s where many fee schedules fall apart.
To address this gap, we’ve created a complimentary fee-setting resource that allows you to:
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Price vaccines as a percentage of the most recently published CDC private-sector cost per dose
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Set lab fees using Medicare’s Clinical Diagnostic Laboratory Fee Schedule (CLFS)
A Complete, Defensible Fee Schedule
By combining:
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Professional services are priced as a percentage of Medicare
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Vaccines benchmarked to CDC private-sector acquisition costs
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Lab services tied to the Medicare CLFS
you can ensure that every component of your fee schedule is intentional, data-driven, and defensible—with no guesswork required.
Get the Tool
We’ve made this resource available at no cost to help practices prepare early and avoid last-minute fee setting. Whether you manage your own fee schedule or support multiple practices, this approach provides clarity, consistency, and confidence heading into 2026.
