Medical Clinic: Fee Schedule

This article was written by our expert who is surveying the industry and constantly updating the business plan for a medical clinic.

Who wrote this content?

The Dojo Business Team

A team of financial experts, consultants, and writers

We're a team of finance experts, consultants, market analysts, and specialized writers dedicated to helping new entrepreneurs launch their businesses. We help you avoid costly mistakes by providing detailed business plans, accurate market studies, and reliable financial forecasts to maximize your chances of success from day one—especially in the medical clinic market.

What services are included in a medical clinic fee schedule, and how are they organized?

Medical clinic fee schedules include consultations, diagnostic tests, procedures, preventive care, emergency services, and ancillary treatments, all categorized using standardized billing codes.

Consultations form the foundation of your fee schedule, covering general practitioner visits, specialist appointments, and family physician services. Each consultation type is assigned specific codes that determine reimbursement rates from insurance providers and help track service utilization patterns within your clinic.

Diagnostic services encompass blood work, imaging studies (X-rays, ultrasounds, CT scans, MRIs), and pathology services. These are typically billed separately from consultations and may be charged per test, per body part, or as bundled packages depending on the complexity of the diagnostic workup required.

Procedures and treatments range from minor office procedures to complex interventions. Your fee schedule should clearly distinguish between different procedure categories: minor procedures (wound care, suturing), intermediate procedures (joint injections, biopsies), and major procedures (surgical interventions). Each category carries different price points based on time, skill level, and material costs.

Preventive care services include vaccinations, health screenings, and wellness checks. These services often receive favorable insurance coverage and may be subject to government subsidies or public health programs. Emergency and after-hours services are categorized separately with premium pricing to reflect the urgency and timing of care delivery.

You'll find detailed market insights in our medical clinic business plan, updated every quarter.

How do consultation fees differ between general practitioners and specialists in a medical clinic?

General practitioner consultations in private medical clinics typically range from $22-$47, while specialist consultations command $47-$94, reflecting the additional expertise and training required.

The fee differential exists because specialists have completed additional years of training beyond medical school and residency, focusing on specific medical domains such as cardiology, orthopedics, or endocrinology. This specialized knowledge justifies the higher consultation rates, which your clinic can charge to patients and negotiate with insurance providers.

In public hospital settings, the rates are significantly lower: general practitioners charge approximately $1-$6, while specialists charge $6-$16. If your medical clinic serves both private and public patients, you'll need to maintain separate fee schedules that reflect these different payment structures while ensuring your clinic remains financially sustainable.

The consultation duration also affects pricing structure. General practitioner visits typically last 15-30 minutes and address common health concerns, preventive care, and referrals. Specialist consultations often require 30-60 minutes due to the complexity of cases, detailed examinations, and treatment planning, justifying the higher fees.

When establishing your medical clinic's fee schedule, consider market positioning: urban clinics generally charge more than rural facilities, and clinics with advanced equipment or specialized services can command premium rates. Your pricing should balance competitive positioning with operational costs and desired profit margins.

What are the current fees for diagnostic tests in medical clinics?

How are procedure and treatment fees determined in medical clinics?

Procedure and treatment fees in medical clinics are determined by complexity, duration, material costs, and standardized point systems, with billing structured either per session or as bundled packages.

The complexity of a procedure directly influences pricing—minor procedures like wound care or simple suturing cost less than intermediate procedures such as joint injections or biopsies, which in turn cost less than major surgical interventions. Your medical clinic should use established coding systems (like CPT codes) that assign relative value units to each procedure based on physician work, practice expense, and malpidity insurance costs.

Duration plays a critical role in fee determination. Procedures requiring 15-30 minutes are priced lower than those demanding 60-90 minutes of physician time. Material costs—including disposable supplies, specialized equipment, and pharmaceutical agents—are factored into the final fee, either as separate line items or incorporated into a bundled price.

Per-session billing works well for single interventions or ongoing treatments where each visit stands alone. For example, physiotherapy sessions typically cost $75-$150 per visit. Package billing offers advantages for multi-session therapies: a 4-week nutrition counseling program might be priced at $500 as a package (versus $700 if billed separately at $175 initial consultation plus three $150 follow-ups).

Surgical procedures and complex treatments often use global fee structures that bundle pre-operative consultation, the procedure itself, and post-operative follow-up care into one comprehensive price. This approach simplifies billing for your medical clinic and provides price transparency for patients, while ensuring all aspects of care are covered financially.

What is the pricing structure for preventive care services in medical clinics?

Preventive care services in medical clinics typically include vaccinations priced at $15-$40 for administration fees and health screenings ranging from $20-$50 for basic panels, with many services partially or fully covered by insurance.

Vaccination pricing depends on whether patients qualify for government programs. The Vaccines for Children (VFC) program provides free vaccines to eligible children, while adults and non-eligible patients pay the clinic's administration fee plus the vaccine cost. Your medical clinic's administration fees typically range from $15-$40 per injection, covering the clinical time, supplies, and documentation required.

Health screenings vary significantly based on comprehensiveness. Basic health panels covering cholesterol, blood pressure, and glucose levels cost $20-$50, while advanced screenings that include cancer markers, comprehensive metabolic panels, or cardiac risk assessments can range from $100-$300. Your fee schedule should clearly differentiate between screening tiers to help patients understand their options.

Insurance coverage plays a major role in preventive care pricing. Many insurance plans cover preventive services at 100% with no patient cost-sharing, following Affordable Care Act guidelines. However, your medical clinic must bill these services correctly using preventive care codes rather than diagnostic codes to ensure proper reimbursement and avoid unexpected patient charges.

Package pricing for preventive care can enhance patient uptake. Annual wellness packages that bundle multiple screenings, vaccinations, and a comprehensive physical examination at a discounted rate (typically 15-25% below individual service costs) encourage patients to maintain regular preventive care while providing predictable revenue for your clinic.

This is one of the strategies explained in our medical clinic business plan.

How are emergency visits and after-hours consultations billed in medical clinics?

Emergency and after-hours consultations in medical clinics are billed at premium rates, typically $150-$200 for general practitioners and $200-$300 for specialists, with additional surcharges applied for services outside regular business hours.

The base emergency visit fee covers the immediate medical assessment, clinical decision-making, and initial treatment provided during urgent situations. General practitioner emergency consultations range from $150-$200, while specialist emergency visits command $200-$300 due to the advanced expertise required for complex or specialized urgent conditions.

After-hours surcharges are added using specific billing codes like CPT code 99053, which designates services provided outside regular office hours. These surcharges typically add $25-$75 to the base consultation fee, compensating your medical clinic for staffing costs, operational expenses, and the inconvenience of maintaining after-hours availability.

Insurance coverage for urgent care varies by plan. Most insurance providers cover emergency visits, though patients may face higher copayments or coinsurance rates compared to scheduled appointments. Uninsured patients pay the full fee, though your medical clinic can offer urgent care packages or payment plans to improve accessibility and collection rates.

Your fee schedule should clearly communicate the total cost structure for emergency services. Transparency about base fees, after-hours surcharges, and potential additional charges (for procedures, medications, or supplies) helps patients understand their financial responsibility and reduces billing disputes. Consider posting emergency fee information prominently in your clinic and on your website to set appropriate expectations.

What are the charges for ancillary services in medical clinics?

Ancillary services in medical clinics include physiotherapy at $75-$150 per session, counseling and psychology services at $70-$120 per session, and nutrition consultations at $175 for initial visits and $150 for follow-ups.

Physiotherapy services are typically billed per session, with fees reflecting the therapist's expertise, treatment complexity, and session duration. A standard 45-60 minute session costs $75-$150, though specialized treatments (sports rehabilitation, post-surgical therapy) may command higher rates. Your medical clinic can offer package pricing—such as 10-session bundles at 10-15% discount—to encourage treatment compliance and secure upfront revenue.

Counseling and psychology services follow a per-session model, generally charging $70-$120 for 50-60 minute appointments. Fees vary based on the provider's credentials (licensed counselor versus clinical psychologist), treatment modality (individual versus group therapy), and specialization (trauma therapy, addiction counseling). Insurance reimbursement rates for mental health services have improved significantly, making these services more financially viable for medical clinics.

Nutrition consultations require different fee structures for initial versus follow-up visits. Initial consultations ($175) involve comprehensive dietary assessment, medical history review, and personalized nutrition plan development, typically lasting 60-90 minutes. Follow-up sessions ($150) focus on progress monitoring and plan adjustments in 30-45 minute appointments. Package programs spanning 4-12 weeks cost $350-$750, offering better value while ensuring patient commitment to dietary changes.

When establishing ancillary service fees for your medical clinic, consider regional market rates, provider qualifications, and insurance reimbursement schedules. Bundling ancillary services with primary care visits or offering membership models that include unlimited access to certain services can differentiate your clinic and improve patient retention.

How frequently should medical clinic fee schedules be reviewed and updated?

Medical clinic fee schedules should be reviewed and updated annually, with additional reviews triggered by regulatory changes, insurance rate adjustments, or significant shifts in operational costs.

Annual reviews align with typical Medicare and Medicaid fee schedule updates, which occur every January. Your medical clinic should conduct a comprehensive fee analysis each year, examining each service category against updated reimbursement rates, market benchmarks, and internal cost data. This systematic approach ensures your fees remain competitive while covering operational expenses and maintaining target profit margins.

Regulatory changes can necessitate mid-year updates. When government agencies adjust reimbursement rates or modify billing requirements, your fee schedule must adapt quickly to maintain compliance and financial viability. Recent years have seen 1-3% annual increases in Medicare physician fee schedules to reflect rising costs of care delivery, and your clinic's fees should track these adjustments proportionally.

Inflation and operational cost increases drive the need for regular fee adjustments. When supply costs, labor expenses, or facility overhead rise significantly, your fee schedule should reflect these realities. However, price increases must be strategic: communicate changes clearly to patients, phase increases gradually to minimize sticker shock, and ensure your fees remain within competitive ranges for your market.

Insurance contract renegotiations provide natural checkpoints for fee schedule updates. When renewing agreements with major payers, review your negotiated rates against your fee schedule maximums. This ensures you're not undervaluing services and leaving revenue on the table while maintaining rates that insurance companies will accept.

We cover this exact topic in the medical clinic business plan.

How do medical clinic fees compare with regional and national benchmarks?

Medical clinic fees are benchmarked against national Medicare and Medicaid rates, regional average charges, and private insurance fee schedules, with private clinic fees typically running 20-50% higher than public facilities and urban clinics charging 15-30% more than rural counterparts.

National benchmarks provide the foundation for fee comparisons. Medicare's Physician Fee Schedule serves as the primary reference point, with most private insurance plans paying 120-200% of Medicare rates. Your medical clinic should position fees relative to these benchmarks: pricing below Medicare rates may raise quality concerns, while pricing significantly above 200% of Medicare may limit patient access and insurance participation.

Regional variations significantly impact competitive positioning. Urban medical clinics benefit from higher income demographics and greater healthcare spending, justifying premium pricing. However, they also face higher operational costs (rent, wages, supplies). Rural clinics typically charge lower fees but operate with reduced overhead, potentially achieving similar margins despite lower absolute prices.

Private versus public sector differences are substantial. Private medical clinics charge $22-$47 for GP consultations and $47-$94 for specialists, while public hospitals charge $1-$6 and $6-$16 respectively. If your clinic serves mixed patient populations, understanding these disparities helps you develop tiered pricing strategies or financial assistance programs that bridge the gap.

Specialty and service mix also affects benchmark comparisons. Clinics offering advanced diagnostics, specialized procedures, or ancillary services can command premium rates above standard benchmarks. Your competitive analysis should compare like services to like: match your fees against clinics with similar service offerings, equipment capabilities, and provider credentials for accurate positioning.

What discounts and financial assistance options should medical clinics offer patients?

• Sliding-scale discounts based on income: Offer reduced fees for patients earning below 200% of federal poverty level, typically providing 25-75% discounts depending on income verification. This approach expands access while maintaining some revenue from services rendered.
• Package pricing for multiple services: Bundle related services at 10-25% discounts compared to individual pricing. Examples include comprehensive physical exam packages, chronic disease management bundles, or wellness program packages that encourage patient commitment while securing upfront revenue.
• Uninsured patient discounts: Provide automatic 15-30% discounts for self-pay patients who settle bills at time of service. This reduces administrative costs associated with billing and collections while improving cash flow for your medical clinic.
• Senior citizen and student discounts: Offer 10-20% reductions for elderly patients on fixed incomes and students, recognizing their financial constraints while building long-term patient relationships and community goodwill.
• Loyalty and membership programs: Create annual membership plans ($500-$1,500) that include unlimited primary care visits, discounted ancillary services, and priority scheduling. This model provides predictable revenue while enhancing patient retention.
• Government subsidy programs: Partner with programs like Vaccines for Children (VFC), Medicaid, and state-funded health initiatives that reimburse your clinic for services to eligible patients, reducing the financial burden of serving vulnerable populations.
• Charity care policies: Establish clear criteria for free or deeply discounted care for patients facing financial hardship. Allocate 2-5% of gross revenue to charity care as part of your community benefit commitment and potential tax advantage.

How does billing differ between insured and uninsured patients in medical clinics?

It's a key part of what we outline in the medical clinic business plan.

What additional fees and surcharges should medical clinic patients expect?

Medical clinic patients should anticipate administrative fees of $10-$40 for documentation and forms, missed appointment charges of $25-$75, and potential after-hours surcharges for services outside regular business hours.

Administrative costs cover services beyond direct clinical care. Medical record requests, insurance form completion, employment physical documentation, and disability paperwork typically incur $10-$40 fees. These charges compensate for staff time and resources dedicated to non-clinical administrative tasks that don't generate insurance reimbursement.

No-show and late cancellation fees protect your medical clinic from revenue loss caused by unfilled appointment slots. Standard policies charge $25-$75 for missed appointments without 24-48 hours notice. Some clinics waive first-offense fees but implement progressive penalties for repeat offenders. Clear communication of this policy at appointment scheduling and confirmation helps reduce no-show rates while justifying charges when necessary.

After-hours and emergency surcharges reflect the premium cost of maintaining extended availability. Services provided evenings, weekends, or holidays may include 20-50% surcharges above standard rates. Out-of-network patients visiting your clinic may face additional fees ranging from 10-30% above standard rates due to lack of contracted agreements and increased billing complexity.

Specialized testing and materials may carry separate charges beyond base service fees. Special pathology stains, rush processing for diagnostic tests, or specialized medical supplies used during procedures can add $25-$200 to final bills. Your fee schedule should clearly indicate when such additional charges may apply, and front desk staff should communicate these potential costs during service scheduling to avoid billing surprises.

Conclusion

This article is for informational purposes only and should not be considered financial advice. Readers are encouraged to consult with a qualified professional before making any investment decisions. We accept no liability for any actions taken based on the information provided.

Sources

1. My FC Billing - Fee Schedule in Medical Billing
2. Japan Ministry of Health, Labour and Welfare - Health and Medical Services
3. CollaborateMD - Medical Billing Process
4. Singapore Medical Association - Fee Guidelines
5. Health Deliver Asia - Cost of Doctor GP Consultations
6. Virtus Diagnostics - Costs of Diagnostic Testing
7. KFF - Vaccine Coverage, Pricing and Reimbursement
8. CMS - Medicare Physician Fee Schedule
9. Dojo Business - Medical Clinic Fee Schedule Competitive Analysis
10. Curogram - Medical Billing Process Steps