Payer Contract Comparison
Two payer offers, one winner — for your code mix, not theirs. Price both contracts against the official Medicare rates and your real volumes.
"120% of Medicare" sounds simple — until you price it against your own code mix. A contract that wins on your top code can quietly lose on the other nine. This tool prices both offers the same way: it takes the official CY 2026 Medicare national rate for each of your codes, applies each payer's terms (a percentage of Medicare, or your own flat rates), multiplies by your annual volumes, and shows you which contract pays more — in total and code by code.
Compare two payer offers
Your codes and annual volumes (flat $ columns are used only when that payer is in flat mode):
Before you sign either offer
- Percentage of which Medicare? Contracts reference a fee schedule year and a locality. This tool uses the CY 2026 national non-facility rate (all GPCIs = 1.000) as the neutral base — if an offer is quoted on a specific year or locality, convert it to this base before comparing percentages.
- Your mix decides the winner. Weight the comparison with your real volumes, not the payer's sample fee schedule — payers showcase the codes where they look generous.
- Rates are only half the contract. Denial behaviour, payment speed, authorisation burden and termination clauses do not appear in a rate table. A slightly lower contract that pays cleanly in 14 days often beats a richer one that denies a fifth of claims.
- Watch the silent codes. Any code priced "by report" or missing from a payer's schedule is priced at the payer's discretion — list those separately in negotiation.
Data: CMS CY 2026 Physician Fee Schedule Relative Value File (RVU26D) — national non-facility rates at the $33.4009 conversion factor. Suspect a payer is paying below even its own contract? Run the remittance through the Underpayment Checker.
Disclaimer: This tool is for educational and estimation purposes only and does not constitute billing, coding or medical advice. Coverage, coding and payment rules vary by payer and change over time — always verify with the current CMS files and the payer's own policy before submitting claims or making financial decisions.
Frequently asked questions
What does 'percentage of Medicare' actually mean?
The payer prices each code as a percentage of what Medicare would pay for it — so 110% of Medicare means 1.10 times the Medicare allowed amount. The catch is which Medicare: the fee schedule year and locality named in the contract. This tool standardises on the CY 2026 national non-facility rate so two offers can be compared on the same base.
Why can a higher percentage contract pay less overall?
Because percentages apply code by code, and your revenue is concentrated in your own code mix. A payer at 115% on codes you rarely bill but 95% on your top three codes can pay less in total than a flat 105% across the board — which is exactly what the volume-weighted totals in this tool reveal.
Should I always choose the contract that pays more here?
Not automatically. This comparison covers rates only. Denial rates, days-to-pay, authorisation requirements, fee-schedule update language and termination rights all change the real value of a contract. Use the rate winner as your starting position, then negotiate the operational terms.