Which fee schedule serves as the base for health insurance plans to determine their own fees?

• A. Medicaid
• B. Medicare
• C. Blue Cross
• D. HMO Schedule

Answer: (B)

Medicare's fee schedule serves as the base. Private health plans often reference the Medicare Physician Fee Schedule (MPFS) as the starting point to set their own reimbursement rates for services. This schedule provides a standardized, publicly available set of values that insurers can anchor to, making payments predictable and comparable across plans. Medicare uses a system of relative values, adjusted for geography, to determine payments for each service, and many payers adopt these baselines even though they may apply their own modifiers or discounts. Medicaid has its own separate schedule and typically pays differently, while Blue Cross and an HMO schedule refer to specific private plans rather than a universal base used by many insurers.