Find Your Contracted Therapy Fee Schedule by Payer

Last reviewed: October 7, 2026.

Your contracted rates live in the payer’s fee schedule for your billing entity, not on a general portal page. Some payers let you look the schedule up yourself; others make you request it in writing. Either way, pull your own practice’s numbers for each product you are contracted for, because allowances differ between products and between practices on the same network.

A common question we get from practice owners is some version of “is there a place to see our current fee schedules? I looked around the portal and couldn’t find anything.” Usually the menu is missing for a reason, and the route depends on the payer.

Why the fee schedule isn’t in your portal

Self-service tools are narrower than they look. The BCBSIL provider-tools page describes its Availity Fee Schedule Listing for participating professional providers in specific commercial networks, not every Blue product. Aetna’s fee-schedule tool page says the online tool does not cover behavioral health providers who are not MDs or DOs, which excludes most therapists. A missing menu is an access limit, not proof you have no contract.

Payer by payer: what has worked for us

BCBS of Illinois: Availity Fee Schedule Listing

In Availity, go to Claims & Payments, then Fee Schedule Listing, choose BCBSIL, and enter the practice’s tax ID, billing NPI, network and place of service. You can enter up to 20 procedure codes per query; psychotherapy codes don’t need modifiers. Run the lookup separately for each network, such as PPO and Blue Choice, because they return different allowances.

In our lookups, office and telehealth returned the same amount within one practice, but two practices on the same network had different amounts for the same code. Never use a colleague’s table as a stand-in. If your biller needs to run the lookup, they need Availity access first; see Authorizing Your Biller for Availity.

Aetna: a written request, from the practice

Aetna’s published route for a full schedule is its provider Contact Us form under the fee-schedules topic, listing every service address and the tax ID. In our experience, Aetna’s fee-schedule team has also turned away a request sent by a billing company and asked for it to come from the practice’s own email. It asked for:

• An Excel spreadsheet with the CPT codes in one column and modifiers in the next, with 00 entered where a code has no modifier.

• The in-network tax ID; it said it only answers in-network providers.

• The provider’s service address.

Aetna schedules for some markets arrive labeled “SAMPLE” because they list commonly used codes. A code that is missing from that list is unknown, not unpaid; ask about it rather than assuming zero. Product-specific programs, such as Aetna’s North Carolina State Health Plan BHAP, carry their own schedules and can’t be used as a general rate.

TRICARE: published maximums

TRICARE publishes the maximum it allows per CPT code by locality on its CMAC rates page, so you can look up 90791, 90834 or 90837 before you sign anything. TRICARE certification is not a network contract; if you later join a regional network, the network agreement sets its own rates. See TriWest Credentialing: Authorized vs. Network.

What to put in any written request

1. Legal name of the contracted entity, its tax ID and billing NPI.

2. Every service address, including whether a location is telehealth-only.

3. The clinician tier or license type, since many schedules price master’s-level therapists differently from doctoral providers.

4. The product or network, such as PPO versus an HMO or exchange plan.

5. The CPT codes and modifiers you bill, and the effective date you need.

Save the returned schedule with the date you received it and the payer’s case or reference number. Store it where whoever posts payments can find both the current and prior versions.

The rate you remember may be out of date

When a practice tells us a payer is “paying short,” we start by pulling the current schedule. More than once, the number the practice had on file came from its original contract and had since been replaced by the payer’s annual updates; recent payments matched the current schedule exactly. Differences between clients turned out to be different products under the same payer, each paying correctly.

A fee-schedule lookup is not a rate negotiation. It tells you what is loaded today. Asking for higher rates is a separate request to the payer’s contracting or provider-relations team, and some payers decline individual negotiations altogether.

If the current schedule still doesn’t match what was paid, work through Insurance Paid Less Than the Therapy Contract Rate.

Frequently Asked Questions

Can I see a payer’s rates before I sign the contract?

Sometimes. Government programs such as TRICARE publish maximum allowances you can check in advance. Commercial payers usually share a schedule with the contract offer or only after you are in network; Aetna, for example, told us it answers fee-schedule requests only for in-network tax IDs.

Can I use another therapist’s fee schedule?

No. Allowances are tied to each contract, so two practices on the same network can be paid different amounts for the same code. Pull your own schedule for each product.

Do telehealth and office visits have different fee schedules?

Within one practice, BCBSIL’s Availity lookup returned the same amount for both in our checks. A group set up as telehealth-only can still be assigned a different schedule area, so tell the payer when you open a physical office.

Sources

• BCBSIL: provider tools and fee schedules

• Aetna: cost estimator and fee schedules

• Aetna: provider Contact Us form

• Aetna: North Carolina State Health Plan BHAP FAQ

• TRICARE: CMAC rates