Guide

The fee-schedule exhibit: never sign with a sample

Summary

The fee-schedule exhibit is the attachment that lists the actual dollar amount you will be paid per CPT code. Ask for the complete exhibit covering every code you bill — not a sample, not the top ten — in writing, before you sign, and confirm whether it is a fixed dollar table or a percentage of a Medicare or proprietary schedule that can move. If a payer will only share a sample, that is your answer.

By Gale Editorial · Updated 2026-07-26. Every figure cited to a dated source. How we write.

What the fee-schedule exhibit is

The fee-schedule exhibit is the attachment to a payer contract that lists what you actually get paid — the dollar amount, or the formula, for each CPT code you bill. The body of the contract sets the rules; this exhibit sets the money. It is the single most important page in the agreement, and it is also the one most often handed over incomplete, as a sample, or 'available on request' after you have already signed.

Everything else in the contract — timely filing, termination, dispute resolution — describes how the relationship runs. The exhibit describes whether it is worth running at all.

Why a sample is not the deal

A sample fee schedule shows a handful of codes at attractive rates and tells you nothing about the ones you actually bill most. A payer can quote a strong rate on a common evaluation code while the psychotherapy or extended-service codes that carry your week sit far lower. Until you see the number attached to every code in your real mix, you do not know your rate — you know a marketing figure. Signing against a sample is signing blind.

Build the request around your own top codes. A rate sheet that looks generous on ten codes and thin on the three you bill every day is a net loss dressed as a win.

How to request the complete exhibit

Put the fee-schedule request in writing before you sign, and be specific: ask for the contracted allowable for every CPT and HCPCS code you bill, in a dated document tied to this contract. Payers publish their reimbursement policies on their provider portals — Aetna posts its clinical policy bulletins 1Ref 1Aetna (2026).Aetna Clinical Policy Bulletins.Named example that a payer publishes its general clinical and reimbursement policies on its provider portal, distinct from the contract-specific rate table a provider must request. and UnitedHealthcare its policies and protocols 2Ref 2UnitedHealthcare (2026).UnitedHealthcare Policies and Protocols.Named example that a payer publishes its policies and protocols on its provider portal, illustrating that portal policies are the rules, not a provider's negotiated fee-schedule exhibit. — but those are the rules, not your negotiated rates. The rate table is contract-specific — ask for it explicitly.

If the response is a sample or a promise to send the full schedule later, treat that as a data point about the relationship you are about to enter. A payer that stands behind its rates has little reason to hide them from a clinician deciding whether to sign.

Fixed dollars vs. a percentage of another schedule

Read how each rate is expressed, not just the number. A fixed dollar amount per code is stable until renegotiated. A rate written as a percentage of the Medicare fee schedule, or of the payer's own proprietary schedule, moves whenever that underlying schedule moves — sometimes down. Ask which one you are getting, and if it floats, ask what it floats on and how often that base changes. That single distinction can outweigh the headline rate over a multi-year term.

This is also where escalators live — the automatic annual rate increases nobody offers unprompted. If the exhibit has none, that is itself a fact worth knowing before you sign, and a reason to plan on asking for a raise once you have a track record.

Medicaid fee schedules are public — commercial ones are not

Not every fee schedule is a negotiation. State Medicaid programs publish their fee schedules openly: Florida's Medicaid agency posts its rates and billing manuals 3Ref 3Florida Agency for Health Care Administration (2026).Florida Agency for Health Care Administration.That Florida's Medicaid agency publishes its fee schedules and billing manuals openly, a named example that Medicaid rates are public unlike commercial fee-schedule exhibits., California's Department of Health Care Services does the same 4Ref 4California Department of Health Care Services (2026).California Department of Health Care Services.That California's Department of Health Care Services publishes its Medicaid fee schedules openly, a named example of publicly available Medicaid rates., and Texas publishes its Medicaid fee schedules through its provider portal 5Ref 5Texas Health and Human Services Commission (2026).Texas Medicaid & Healthcare Partnership (TMHP).That Texas publishes its Medicaid fee schedules through its provider portal, a third named example that state Medicaid rates are public rather than request-only.. If you contract with Medicaid, you can look the numbers up before you enroll rather than requesting them. Commercial rates are the opposite — private, contract-specific, and disclosed only when you ask.

The practical upshot: the effort of chasing a complete exhibit is a commercial-contracting task. For Medicaid, the exhibit is already on the state agency's website, tied to the same enrollment you are completing.

Before you sign — the checklist

Run the exhibit through five checks before your signature goes down. Confirm it lists every code you bill, not a sample. Confirm each rate as a fixed dollar or a clearly defined percentage. Check for a lesser-of clause, which can quietly pay you the lower of your billed charge or the allowable and turn undercharging into underpayment. Confirm any escalator language. And keep the dated exhibit in your contract file, because it is what you audit paid claims against.

The exhibit only tells you what a payer pays. Pair it with your fee schedule — your own master list of charges — so you can see, code by code, where a lesser-of clause or a low allowable is quietly costing you money each month.

Common questions

It is the attachment to a payer contract that lists what you get paid for each CPT or HCPCS code — either as a fixed dollar amount or as a formula, like a percentage of the Medicare fee schedule. The body of the contract sets the rules; the exhibit sets the money. It is the page that determines your actual revenue, which is why you want the complete version before signing.

A payer can decline, and some share only a sample or say the full schedule is available after signing. That refusal is itself information: you would be agreeing to rates you cannot see. Make the request in writing, ask for every code in your billing mix, and weigh a refusal seriously. A payer confident in its rates usually has no reason to withhold them.

A fixed dollar rate stays put until you renegotiate. A percentage-of-Medicare or percentage-of-proprietary-schedule rate moves whenever that underlying schedule changes, which can mean a cut you never agreed to directly. Neither is automatically better, but you should know which you have, what it floats on, and how often the base updates before you commit to a multi-year term.

State Medicaid fee schedules are published openly on each state agency's site — Florida, California, and Texas all post theirs — so you can look up the rates before enrolling. Commercial fee schedules are private and contract-specific, disclosed only on request. So the effort of chasing down the complete exhibit applies mainly to your commercial contracts, not your Medicaid enrollment.

Confirm it covers every code you bill, not a sample; that each rate is a fixed dollar or a clearly defined percentage; whether a lesser-of clause could pay you the lower of your charge or the allowable; and whether any escalator raises rates over time. Then file the dated exhibit so you can audit paid claims against it later.

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References

1.Aetna (2026). Aetna Clinical Policy Bulletins. Aetna provider portal. link ✓Named example that a payer publishes its general clinical and reimbursement policies on its provider portal, distinct from the contract-specific rate table a provider must request.
2.UnitedHealthcare (2026). UnitedHealthcare Policies and Protocols. UnitedHealthcare provider portal. link ✓Named example that a payer publishes its policies and protocols on its provider portal, illustrating that portal policies are the rules, not a provider's negotiated fee-schedule exhibit.
3.Florida Agency for Health Care Administration (2026). Florida Agency for Health Care Administration. Florida Agency for Health Care Administration. link ✓That Florida's Medicaid agency publishes its fee schedules and billing manuals openly, a named example that Medicaid rates are public unlike commercial fee-schedule exhibits.
4.California Department of Health Care Services (2026). California Department of Health Care Services. California Department of Health Care Services. link ✓That California's Department of Health Care Services publishes its Medicaid fee schedules openly, a named example of publicly available Medicaid rates.
5.Texas Health and Human Services Commission (2026). Texas Medicaid & Healthcare Partnership (TMHP). Texas Health and Human Services Commission. link ✓That Texas publishes its Medicaid fee schedules through its provider portal, a third named example that state Medicaid rates are public rather than request-only.

https://www.gale.care/for-providers/ct-fee-schedule-exhibit · 5 sources. Competitor details are cited to dated public sources and maintained as they change; figures are estimates, not commitments. Synthetic demonstration.

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