UCR fee
A UCR fee, short for usual, customary and reasonable, is a practice's own full fee for a procedure, set independently of what any insurance plan pays. Practices compare their UCR fees with regional percentile data to check they are not priced below the market, and the term has a second meaning on the payer side.
Why it matters to the front desk
The second meaning belongs to the payer. For an out-of-network claim, a payer applies its own determination of a usual and customary allowed amount, which is not the practice's fee. Staff read the context to know which of the two meanings is in play.
In network, the practice has a signed fee-schedule contract with the payer, so the allowed amount is usually lower than the UCR fee. Out of network, the practice bills at its own UCR fee and the payer pays according to the patient's out-of-network benefit, often less and sometimes nothing. For an in-network patient, the gap between the UCR fee and the contracted allowed amount is the contractual write-off; out of network, the patient usually owes that difference.
Related terms
Insurance Verification
Checks a patient's dental insurance with the payer, for one patient or the whole day's schedule, and returns coverage and benefits in a summary you can download.
See how Insurance Verification works