Here is the answer up front. Your PPO reimbursement is set by each plan's fee schedule, and many of those schedules can be negotiated higher. Not every payer will move, and the size of any increase varies, but practices that ask with the right data and the right leverage often come away with better contracted rates. This page explains what a fee schedule is, when you have room to push, and exactly how to make the request.
Last updated June 2026 · Reviewed by the PracticeAlpha billing team
The short version. When you join a PPO network, you agree to accept that plan's fee schedule, which caps what you collect on every in-network procedure. Those caps are not carved in stone. You can request your current schedule, benchmark the codes that matter most to your collections, and submit a formal case for higher fees. Some payers say yes, some offer a partial bump, and some say no.
The rest of this guide walks through how fee schedules limit you, where your leverage comes from, the step-by-step way to negotiate, and what a realistic outcome looks like.
Every in-network dollar you collect runs through one document. Most owners have never read theirs closely.
A PPO fee schedule is the list of contracted amounts a plan agrees to pay for each procedure when you are in network. For every CDT code, the schedule sets an allowed amount. That figure, not your office's full fee, is what governs the claim.
Here is the mechanics of it. Say your office fee for a procedure is one number and the plan's allowed amount is lower. When you are in network, you write off the difference. The plan pays its share of the allowed amount, the patient pays the rest of the allowed amount, and your full fee never enters the picture. You collect the allowed amount and nothing more.
Multiply that across a busy schedule and the effect is large. The fee schedule quietly sets the ceiling on the revenue of every in-network case you treat. Two practices doing identical dentistry can collect very different amounts simply because one signed a stronger schedule than the other.
That is the part worth sitting with. The fee schedule is a contract, and contracts can be revisited. The allowed amounts you were handed when you first credentialed are a starting position, not a permanent one. If you have never asked a payer to raise them, you are very likely accepting the lowest rate that plan was willing to offer.
A payer raises fees when keeping you in network clearly serves its members. Leverage is just evidence that you matter to them.
You bring strong patient volume tied to the plan. If a meaningful number of that plan's members see you, dropping or underpaying you creates a gap for those members to fill. Volume is the most direct form of leverage, because it ties the payer's network adequacy to your office.
You offer a specialty or service mix the network is short on. If you provide procedures that few in-network providers near you handle, the plan needs you more than it needs the average general office. A distinctive service mix is hard for a payer to replace.
Your region has few in-network providers. In areas where a plan is thin on participating dentists, network adequacy rules and member access give you a stronger hand. The fewer alternatives the plan has, the more your participation is worth to it.
You have access through umbrella or leased networks. Some plans reimburse through shared, leased, or umbrella networks, and the schedule attached to one access point can differ from another. Understanding which network you are actually paid through, and whether a better path exists, is leverage in itself.
If none of these clearly describe you, you can still ask, but go in with realistic expectations. Leverage is not all-or-nothing, and even a modest case is better than never making one.
Not sure which of your plans are underpaying you? We can analyze your fee schedules against your code mix and show you where the gaps are before you negotiate anything.
Get a free AR analysisNegotiation is a process, not a phone call. Work through it in order and let the data carry the request.
Ask every plan, in writing, for your full current fee schedule. You cannot negotiate against numbers you have not seen, and many offices have never pulled the complete list. Get the allowed amount for each code you actually bill.
You will not move every code, so focus where it counts. Pull a report of the codes you bill most often and the ones that carry the most revenue per claim. A small increase on a code you submit constantly is worth more than a large one you rarely use.
Line up each target code's allowed amount against your full office fee and against your other plan contracts. The gaps show you which payers lag, and a payer that pays well below your other schedules is the clearest case to bring forward.
Assemble the evidence behind your ask. Your patient volume with the plan, your service mix, your local network position, and the benchmark gaps all belong in the file. A request grounded in specifics is far harder to wave off than a general appeal for more money.
Send a clear, written request to the payer's provider relations or network contracting team. Name the specific codes, state the increases you are asking for, and attach your supporting case. A formal, documented ask gets routed and answered far more reliably than a casual phone inquiry.
Some practices hand the process to a specialist who negotiates PPO fees for a living. They know which plans tend to move, how to frame the request, and how to push through the back-and-forth. If the work is more than your team can take on, a negotiator can be worth the cost.
Negotiation is not a guarantee, and it helps to go in clear-eyed. Not every plan will move. Some payers grant increases on the codes you target. Some come back with a partial offer, raising a few codes while holding others. Some decline outright, and that is a normal outcome rather than a sign you did something wrong.
Increases also vary. The amount a plan is willing to add depends on your leverage, your market, and the payer's own contracting posture, so there is no standard figure to expect. What matters is the shape of the win, not a headline percentage. An increase that carries across a code you submit on a large share of claims compounds quietly across the year, which is why targeting your high-volume codes matters more than chasing the biggest single bump.
Treat the whole effort as a campaign rather than a one-time event. You may get a yes from one payer, a maybe from another, and a no from a third in the same round. Document every response, because a no this year is not always a no next year, and the data you gathered makes the next request faster to assemble.
Fee schedules are not a set-it-and-forget-it item. Most contracts do not raise their allowed amounts on their own, so a schedule you accepted years ago can drift further behind your costs every year you leave it alone. The remedy is a regular review.
Put your schedules on a recurring cycle. Re-pull the current allowed amounts, re-benchmark your high-volume codes, and check whether your leverage has changed. A practice that has grown its volume, added a service line, or watched competitors leave a network has fresh grounds to ask again, even from a payer that declined before.
This kind of ongoing fee-schedule hygiene fits inside a healthy revenue cycle. If you want the full picture of how contracted rates, claims, and collections connect, our overview of dental revenue cycle management shows where fee negotiation sits in the larger system.
Most practices know their fees feel low but cannot point to which plans and which codes are doing the damage. That is the gap we close. We analyze your fee schedules against your actual code mix, so you can see exactly where each payer sits relative to your office fees and your other contracts before you spend any effort negotiating.
That analysis turns a vague sense of being underpaid into a ranked, specific target list. You learn which plans lag the most, which of your high-volume codes carry the largest gaps, and where the leverage in your patient base and local market actually lives. From there, a request is built on numbers rather than hope.
Fee analysis does not stand alone. It connects to clean claims, accurate coding, and the credentialing that keeps you in network in the first place. You can pair it with full dental billing services if you want claims and follow-up handled end to end, or with dental credentialing services when your network participation and contracts need attention together.
The honest framing is simple. We help you see what you are actually being paid and where the room to do better is. What you decide to negotiate, and with whom, stays your call.
Yes. PPO reimbursement is set by each plan's fee schedule, and many of those schedules can be renegotiated. Whether a given payer raises your fees depends on your leverage and how you make the request. Some plans move, others hold firm, but the only way to find out is to ask with a clear case behind you.
A PPO fee schedule is the list of contracted amounts a plan agrees to pay for each procedure code when you are in network. For each CDT code the schedule sets an allowed amount, and your reimbursement is capped at that figure regardless of your office's full fee. Patients are billed only up to the allowed amount, so the schedule directly controls what you collect on in-network work.
Leverage tends to come from strong patient volume tied to a plan, a specialty or service mix the network is short on, a region with few in-network providers, or access to better schedules through an umbrella or leased network. A plan is more willing to adjust your fees when keeping you in network clearly serves its members.
Begin by requesting your current fee schedule from each payer in writing. Then identify your highest-volume and highest-value codes, benchmark the allowed amounts against your office fees and your other contracts, and submit a formal written request that names specific codes and the increases you are asking for. Many practices also use a third-party negotiator to handle the back-and-forth.
There is no fixed amount, and results vary widely by payer, region, and your leverage. Some plans grant increases on the codes you target, some offer a partial move, and some decline entirely. Set the expectation that not every plan will budge, and treat any increase that carries across your high-volume codes as meaningful because it compounds across every claim.
Fee schedules should be reviewed periodically rather than set once and forgotten. Office fees, code mix, and your market position change over time, and many contracts do not raise allowed amounts on their own. Revisiting your schedules on a regular cadence keeps reimbursement aligned with current costs and gives you fresh data to support the next request.
Free AR analysis. We pull your numbers, compare your fee schedules against your code mix, and show you which payers are underpaying you and where you have room to negotiate. 30 minutes. No commitment.