Without fee schedules, healthcare providers typically charge their full gross charge rates under Letters of Protection. These rates are listed in what’s called a chargemaster, which is like a menu of sticker prices for medical services. When patients have traditional health insurance, the actual amount paid by insurance is lower than the full chargemaster rate because of negotiated discounts. But under Letters of Protection, providers might expect to be paid their full chargemaster amount.

Healthcare providers take on a lot of risk with Letters of Protection because they might not get paid for years, or payment may never come. So, it’s fair for them to charge reasonable fees, as long as they’re not much higher than what other providers charge for the same service.

Gross charge fee schedule rates are often based on a percentage of what Medicare pays for the same service. For example, a doctor’s office might set fees anywhere from 250% to 3,000% of the Medicare rate or more. The national distribution of gross charge rates for common medical services are listed for five medical and surgical specialties below.

Providers who often work with Letters of Protection should periodically check their fees against the market to make sure they’re not charging too much or too little. Setting clear rate expectations for medical services in advance benefits everyone involved in Letters of Protections, including providers, patients, and the lawyers handling the cases.

Gross fee charges of PM&R docs vary wildly nationwide. Office-based evaluation and management services may defensibly range from 300% to 500% of Medicare, while many injection procedures range from 1,000% to 3,500% or more of Medicare nationwide. 

The nationwide charge markups in the table below for PM&R services do NOT reflect Fair Market Value fee ranges for individual markets.