2016 Usual, Customary and Reasonable (UCR) Fees
The term “Usual, Customary and Reasonable,” as it relates to any fee schedule, can be confusing. At The Neck and Back Clinics, we take the topic seriously by periodically verifying that our fees for services meet the definition of UCR and making adjustments, as necessary. The Neck & Back Clinics strives to be the leader of our industry in every way, including the determination of usual, customary and reasonable fees. We appreciate the opportunity to work with patients and provide them with high quality healthcare as they work toward recovery, and we want our patients and any referring colleagues to be confident that our patients receive high value for services that are fairly priced in the marketplace. The following bullet points explain the process of how we set our fees.
✓ To ensure “Usual, Customary and Reasonable” fees, The Neck & Back Clinics continues to utilize two nationally recognized publications.
- First, the 22nd edition of Medical Fees, published in 2016 by Practice Management Information Corpo-ration. As stated in the book’s foreword, “The UCR fees listed in this publication are derived from an analysis of over 600 million actual charges.”
- Second, the 33rd edition of Physicians’ Fee Refer-ence, published in 2016 by Yale Wasserman, DMD Medical Publishers Ltd.
✓ Within these two publications, one will find the nationally averaged 50th, 75th, and 90th percentile fees for all CPT codes. The two publications do not list identical fees for each CPT code, but the amounts are similar. (See below for defi nition of CPT code.)
✓ Both publications list “Geographic Adjustment Factors” meant to help providers “fine tune” their fees based on work, practice, and malpractice expenses specifi c to a geographic region.
✓ The fee for each CPT code used at The Neck & Back Clinics is set at the 67th percentile, adjusted for Clark County, Nevada, and averaged between both publications.
Click here to download the actual UCR Fees document and to see an example of the formula used by The Neck & Back Clinics to determine our fees. Please feel free to contact us with any questions or for further explanation.
CPT is a registered trademark of the American Medical Association. CPT stands for “Current Procedural Terminology.” A CPT code is a five digit numeric code that is used to describe healthcare related procedures provided by physicians, hospitals, and other health care providers. Every procedure has an accompanying code.