Fee Schedule Management: Best Practices for Aesthetic Practices
Fee schedule management: keep one dated price list, compare it with payer allowed amounts, review it yearly and log every change. Steps and checks.
Fee schedule management means keeping one dated list of what your practice charges for each service, checking it against what each payer actually allows under your contracts, and reviewing both on a set schedule with a log of every change. In an aesthetic practice there are usually two lists to manage:
- Your own fee schedule (charge master): the price you set for each service, product, package and membership. Self-pay patients pay from this list, and claims go out at these charges.
- Payer fee schedules (allowed amounts): what each insurer agrees to pay for a code under your contract. For Medicare, the Physician Fee Schedule sets these amounts.
- Self-pay estimates: under the No Surprises Act, uninsured and self-pay patients must receive a good faith estimate of expected charges, so the self-pay list has to be current.
Sources checked October 14, 2026 · Prepared by Prospyr. This update replaces an earlier version that included unsourced pricing ratios, membership prices and revenue results. No certified-coder or financial review is claimed. CPT is a registered trademark of the American Medical Association; use the current licensed code set.
Build your own fee schedule
Start from cost, then check the market.
- List every service you sell. Use one line per service, with the code where one applies, the product and units used, the provider type and the typical time.
- Work out the cost to deliver it. Include product cost, provider time, room and equipment time, and a share of overhead. This is your floor.
- Check local prices. Look at what nearby practices publish for comparable services. Price for your positioning, not only to match.
- Define packages and memberships plainly. Write down exactly what each one includes, how long it lasts and what happens to unused visits.
- Use one charge per service. Apply the same list charge no matter who pays, and handle self-pay discounts as a written, consistent policy rather than ad hoc changes at checkout.
Some practices use Medicare's published amounts as one reference point. The Medicare PFS Look-Up Tool shows national and locality payment amounts by code. CMS builds each amount from three relative value units (work, practice expense and malpractice), adjusts each for location with a geographic practice cost index, and multiplies the sum by a dollar conversion factor. The statute sets how the conversion factor is updated each year, and CMS updates the fee schedule quarterly. Most cosmetic services have no Medicare payment at all, so this reference only helps for medically necessary services.
Compare your charges with payer allowed amounts
If you bill any insurance, read each contract's payment terms. If a contract pays the lower of your billed charge and the allowed amount, a charge set below the allowed amount leaves money unpaid. Check this for your highest-volume codes first:
| Check | What to compare |
|---|---|
| Charge vs allowed | Your list charge against each payer's contracted amount for the same code |
| Paid vs contracted | What the remittance (ERA or EOB) actually paid against the contract rate |
| Adjustment codes | The claim adjustment reason code on any line paid differently than billed |
| Effective dates | Whether a new contract rate or code change has reached your billing system |
A payer that pays below its contract rate is an underpayment to follow up with that payer. A charge below the allowed amount is a fee schedule problem to fix on your side.
Set a review cycle
- At least yearly. Review the full list once a year. Many payer changes and code-set updates take effect January 1, so a late-year review keeps you ahead of them.
- When something changes. Update when a payer contract changes, a new service launches, product or supply costs move, or codes are added, revised or deleted.
- Monthly spot checks. If you bill insurance, compare paid amounts with contract rates on a sample of remittances.
Log every change
Keep a change log with the date, the service or code, the old and new charge, the reason and who approved it. Keep prior versions. This makes it possible to answer a patient or payer question about what a service cost on a given date.
Tell patients before prices change
Tell patients about price changes before they book, and make sure the front desk can explain what a package or membership includes. For self-pay patients, a good faith estimate is due within 1 business day of scheduling when the service is booked at least 3 business days ahead, within 3 business days when it is booked at least 10 business days ahead, and within 3 business days of a request. For recurring services, one estimate can cover up to 12 months.
Train the team on the list
- Front desk: where the current list lives, what packages and memberships include, and how to answer price questions.
- Billing team (if you bill insurance): how contract rates map to codes, how to read remittances, and how to flag a mismatch.
- Providers: that the service documented in the chart must match what is charged.
Where Prospyr fits
Prospyr supports charting, digital intake, inventory, packages, memberships and practice operations for self-pay services. Prospyr does not submit insurance claims or manage payer contracts; practices that bill insurance heavily need a separate claims solution.
Sources
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Self-pay estimate workbook
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