By Josh Nakka | Healthcare Market Intelligence – Visit my website
More than 60% of UHC’s physician group E/M contracts are below Medicare.
In our review of the February Transparency in Coverage publishing for UnitedHealthcare’s Choice PPO network, limited to Evaluation & Management codes for physician groups, we found that 61% of groups are reimbursed below 2026 Medicare.
That is the national average. In some states it is materially higher:
- Florida sits at 77%.\
- Michigan is above 72%.
- Texas is over 73%.
But one thing that stands out is the dispersion. You can see it in the spread column of the graphic. There is no single “UHC rate” for physician groups in a state. Within the same market, the spread between the 25th and 75th percentile contracts averages more than 50 percentage points of Medicare. In some states, the gap is even wider.
That means two physician groups in the same geography, billing the same E/M codes, can be paid dramatically different rates under the same payer and product line. - Some are above Medicare.
- Many are below and the distance between them is substantial.
When people talk about commercial reimbursement, they often compare it to Medicare as if it is a single benchmark. But the market is layered. It is negotiated.
And it is uneven.
The question is not just whether a contract is below Medicare. It is where you sit relative to your local market distribution. Are you at the 25th percentile? The median? The 75th? That context changes the negotiation.
This analysis comes from PriceMedic.com and the PriceMedic Core dataset built from Transparency in Coverage files across 200+ commercial payers, including
