Lab Fee Schedules

January 1, 2007

This question regards fee-schedule creation. We use Quest for our labs, and it has provided client pricing for the labs we do. We then bill the insurance company, and we pay Quest the negotiated fee. We based our fees on Medicare’s fee schedule, setting our labs at 300 percent of what Medicare pays. I think we’re undercharging. Any ideas on how to base our lab fee schedule outside of Medicare’s schedule? Is there another standard for lab fees/reimbursements?

Question: This question regards fee-schedule creation. We use Quest for our labs, and it has provided client pricing for the labs we do. We then bill the insurance company, and we pay Quest the negotiated fee. We based our fees on Medicare’s fee schedule, setting our labs at 300 percent of what Medicare pays. I think we’re undercharging. Any ideas on how to base our lab fee schedule outside of Medicare’s schedule? Is there another standard for lab fees/reimbursements?

Answer: Medicare pays for very few tests, so if it pays zero, your 300 percent multiplier still earns you zero.

With respect to what to charge, you can capture data from your EOBs regarding what you actually get paid.

You can also set your fees as a multiple of Quest charges.