Rate Benchmarking
Compare your rates with similar providers.
Select a published rate, define comparable providers, and see where that rate falls in your market.
See a sample rate comparisonHCPCS M1055 Fee Schedule
HCPCS M1055 is classified under Screening Procedures, in the Anticoagulation Management subgroup.
Aspirin or another antiplatelet therapy used
| Key Fact | Detail |
|---|---|
| Service Type | Screening Procedures Anticoagulation Management |
| Complexity Level | Low |
National average reimbursement for HCPCS M1055 by major payers:
$70.12
BCBS / Anthem
$N/A
UnitedHealthcare
$49.42
Aetna
$0.00
Cigna
Compare published rates across providers.
Choose a payer to see a sample of rates for HCPCS M1055.
HCPCS M1055
No sample rates available for this payer and code. Search provider rates to explore coverage.
Get a free rate benchmark for your specialty.
Choose your state and specialty to build a report from payer-published rates.
Use market rates to prepare your payer proposal.
Payer Contract Negotiation
Draft a fee schedule renegotiation letter.
Use your fee schedule and market benchmarks to set target rates and draft a letter for your payer.
See a sample payer proposalHCPCS M1055 vs. Other Anticoagulation Management Codes
The table lists codes related to M1055. Select one to see its fee schedule.
| Code | Complexity | Description |
|---|---|---|
| M1054-HCPCS | Low | Patient had only urgent care visits during the performance period |
| M1055-HCPCS | Low | Aspirin or another antiplatelet therapy used |
| M1056-HCPCS | Low | Prescribed anticoagulant medication during the performance period, history of gi bleeding, history of intracranial bleeding, bleeding disorder and specific provider documented reasons: allergy to aspirin or anti-platelets, use of non-steroidal anti-inflammatory agents, drug-drug interaction, uncontrolled hypertension > 180/110 mmhg or gastroesophageal reflux disease |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including HCPCS M1055. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the M1055 fee schedule helps patients estimate costs and providers optimize billing for accurate reimbursements.
Factors that affect fee schedules
Medicare & Medicaid Rates
Government-set reimbursement amounts
Private Insurance Rates
Negotiated rates between providers and insurance companies
Geographic Location
Costs may be higher in urban areas.
Provider Type
Hospital providers may have different rates than private practice.
FREE SAMPLE MARKET COMPARISON
Let's review your payer contracts side-by-side with the market.
Bring your top codes (like HCPCS M1055) and we'll show you how you compare in 15 minutes or less.