Fee Schedule vs Medicare Benchmark Gap Analyzer for eClinicalWorks Using Practices

See Which Codes Are Priced Wrong, and by How Much

eClinicalWorks will show you your contracted rate for any CPT code without hesitation. It has no idea what that rate should be against the current Medicare conversion factor, or against what your market actually pays for the same work.

CMS set two Medicare conversion factors for 2026: $33.40 for most physicians, $33.57 for qualifying APM participants, both up from $32.35 in 2025. This analyzer uses that real number as the floor, then measures your contracted rate against a commercial target you control, since no single percentage applies evenly across every specialty and region.

What's Inside This Analyzer?

One workbook, three tabs: the real 2026 Medicare numbers, a place to log every code, and a ranked list of what's underpriced and what's overpriced.

1. Medicare-Market Benchmarks

• Both 2026 Medicare conversion factors are built in, sourced from the CMS Physician Fee Schedule Final Rule >
• A commercial target percentage comes prebuilt, backed by actual market research rather than a round number picked at random
• Complex specialties and primary care get different guidance, since MGMA and Milliman both show the gap varies by specialty
• Every figure is editable the moment your own contract data says otherwise

2. Fee Schedule Data Input

• CPT code, your contracted rate, and the Medicare allowable for your locality get entered once per code
• Percent of Medicare and the gap against your target calculate on their own
• Annual volume turns a percentage gap into an actual dollar figure per code
• Codes get flagged Underpriced, Overpriced, or Aligned, not left as a raw number for someone to interpret

3. Fee Schedule Gap Diagnostic

• Every code's dollar impact rolls up into one ranked list
• Codes sort by size of the gap, worst first, whether that means money left on the table or a rate that's hard to defend
• One view across your whole fee schedule instead of a code-by-code guessing game
• Rerun it after a contract renegotiation and see whether the gap actually closed

Built for Healthcare Leaders Responsible for Fee Schedule & Contract Performance

Built for the people who have to walk into a payer negotiation with a number, not a feeling.

Practice Administrators

Know which codes to bring to the table first, before the payer sets the agenda.

Billing Directors & Managers

See where the fee schedule is quietly losing money, code by code, instead of only at the aggregate level.

CFOs & Finance Leads

Turn a contract renegotiation into a ranked list of dollar opportunity instead of a vague ask for more.

Payer Contracting Managers

Walk into the next negotiation with the specific codes and the specific numbers that make the case.