Multispecialty Fee Schedules

February 1, 2004

Should we have one fee schedule for specialists and another for primary care?

Question: Should we have one fee schedule for specialists and another for primary care?

Answer: Multispecialty practices often feel they need two fee schedules. The specialists worry they are getting less than they could if the rate were set at, say, a measly primary multiplier of 250 times Medicare.

However, keeping to one fee schedule really doesn't handicap specialists. That is because the vast majority of codes used are specialty specific, except for the E&Ms - and those should be the same for management reporting purposes and perception from the public.

In other words, if you changed the fee for a vaginal delivery, only the OB/GYN would care since no one else provides that service. It's the same for the other specialties.

That said, some practices do set their E&Ms at, say, 200 percent of Medicare, and their procedures at 300 percent. This provides a happy medium between the primary care and specialist physicians since the latter are using those procedures to generate the vast majority of their revenue.