How do I know if my practice is underpaid by an insurance company?

Compare your contracted allowed amount for a code against the distribution of rates the payer itself publishes under the federal Transparency in Coverage rule. If your rate sits below the 25th percentile of the payer's own disclosed contracts for the same code and setting, most comparable groups negotiated more than you did for the identical service — the clearest available signal that you are underpaid.

Where does this benchmark data come from?

Directly from the machine-readable files each insurer is federally required to publish, listing its negotiated rate with every in-network provider group. We normalize those disclosures into aggregate benchmarks — median, 25th–75th percentile range, and percent of Medicare — refreshed on the same monthly cadence the rule requires. No surveys, claims samples, or estimates.

What does “percent of Medicare” mean?

It expresses a commercial rate as a multiple of the Medicare Physician Fee Schedule allowed amount for the same service. Payer contracts are very often written this way, so converting your rates to a percent of Medicare lets you compare across codes, payers, and years on one common scale — and phrase a renegotiation ask in the language contracting teams already use.

Can I actually negotiate a higher rate with my payer?

Usually, yes. Most commercial agreements allow a renegotiation request or renew on an anniversary date, and payers do adjust rates for practices that arrive with data. Showing that your rate sits below the published market median for the identical service is a far stronger opening than asking for a flat percentage increase.

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Every major insurer is federally required to publish the rates it has negotiated with every provider group. Pick a payer and a CPT code below and see the published market — the median, the middle-half range, and the percent of Medicare — so you can tell at a glance whether your contract is keeping up.

Method: aggregate benchmarks built from payers’ own Transparency in Coverage machine-readable files, refreshed monthly, collapsed to one representative professional rate per contracting group with payment-reducing modifier lines excluded. Aggregate only — no individual practice or contract is identified.

PayerCPT code

Scope to Tennessee contracts only

No account needed. Benchmarks are aggregate-only, built from the payers’ own published rate files.

How to read the result

The medianis the middle contract: half of the payer’s contracting groups are paid more for the code, half less. The 25th–75th percentile rangeis where the middle half of contracts sit — the practical negotiating band. Your contracted rate below the 25th percentile means most comparable groups negotiated more than you did for the identical service; that gap, multiplied by your annual volume, is usually the strongest line in a renegotiation request. When you’re ready to make that case, start with our renegotiation guide.

Frequently asked questions

How do I know if my practice is underpaid by an insurance company?: Compare your contracted allowed amount for a code against the distribution of rates the payer itself publishes under the federal Transparency in Coverage rule. If your rate sits below the 25th percentile of the payer's own disclosed contracts for the same code and setting, most comparable groups negotiated more than you did for the identical service — the clearest available signal that you are underpaid.
Where does this benchmark data come from?: Directly from the machine-readable files each insurer is federally required to publish, listing its negotiated rate with every in-network provider group. We normalize those disclosures into aggregate benchmarks — median, 25th–75th percentile range, and percent of Medicare — refreshed on the same monthly cadence the rule requires. No surveys, claims samples, or estimates.
What does “percent of Medicare” mean?: It expresses a commercial rate as a multiple of the Medicare Physician Fee Schedule allowed amount for the same service. Payer contracts are very often written this way, so converting your rates to a percent of Medicare lets you compare across codes, payers, and years on one common scale — and phrase a renegotiation ask in the language contracting teams already use.
Can I actually negotiate a higher rate with my payer?: Usually, yes. Most commercial agreements allow a renegotiation request or renew on an anniversary date, and payers do adjust rates for practices that arrive with data. Showing that your rate sits below the published market median for the identical service is a far stronger opening than asking for a flat percentage increase.

Source: payer Transparency in Coverage machine-readable files. Aggregate benchmarks only. EarnestMD is independent and not affiliated with any insurer. This page is informational and is not legal or payer-contracting advice.