Dental fee schedule review: update your fees before January

A dental fee schedule review is a once-a-year pass over the office's own full fees, ending in a new fee list and its effective date. Run it in October or November; OpenDental 24.4 or later can load fees then with a January 1 effective date. A single office and a group run the same steps.

What goes on the fee schedule review worksheet?

Start with the one-afternoon check in the UCR fees and dental fee schedules glossary entry, which defines the terms. Carry its columns over; this sheet, one row per code, takes each code to a decided fee.

The report sits in Standard Reports, Daily, as Production by Procedures from 24.4 (see the 24.4 release notes); the 24.3 manual describes its grouped-by-code version. Sort by count, for the codes the front desk quotes daily, and by total fees, for the codes that carry the dollars. Codes on either short list get their own decision. The rest move together by one owner-approved Increase by %, except codes already at or above target, which hold.

The average fee should sit close to the office fee in effect for most of the year. If not, fees come from elsewhere: a provider on another schedule, a clinic-specific fee, a mid-year change, a patient-level schedule, a Medicaid or percentage plan's own schedule, or PPO fees billed instead. Find out which first, or the increase never reaches a claim.

Before comparing, confirm each PPO schedule in OpenDental matches the carrier's latest; a stale one makes every flag wrong.

Why the flag column matters most

A fee below any contracted allowance can cost money on that plan's claims: many PPO contracts pay the lesser of the submitted fee and the allowance, so the difference stays with the plan. A fee exactly at the allowance costs nothing today, but leaves any future allowance increase unclaimed. Terms differ by carrier and plan, so check your own contracts.

Per OpenDental's fee schedule logic page, the schedule in Edit Insurance Plan drives the write-off, not the billed fee, and the preference "Use UCR fee for billed fee even if PPO fee is higher" decides whether the lower office fee or the higher PPO fee goes on the claim. The ADA dental claim form guide covers why the claim should carry your full office fee.

How do you decide what the new fee should be?

The ADA's dental care market page says it cannot quote fees and that federal law forbids it to set or recommend them; it discontinued its Survey of Dental Fees in 2023, citing a change in law. A number sold as "the ADA fee" is either old or not from the ADA.

Percentile fee data by area is licensed. FAIR Health's fee estimator for healthcare professionals covers dentistry, with benchmark charges from the 50th to the 95th percentile across 493 geozips, areas typically based on the first three digits of a zip code. Searching dental fees by zip code may surface FAIR Health's free consumer site, which its terms reserve for consumer use. Paid dental fee surveys are the other source; check that one reports full charges, by zip area, from recent claims. Out-of-network EOBs are a free check: when a carrier routinely allows your full submitted fee on a code, your fee likely sits below its UCR.

A percentile by zip beats a state or national average: it ranks your fee against local fees for that code, so one percentile works as policy across hundreds of codes.

• Fix every flagged code first. A fee below a contracted allowance is wrong at any percentile.
• Write down one target percentile for the whole schedule, signed by the owner.
• Move codes far below the target in steps, hold codes at or above it, and note the plan on the sheet.

How do you update fees in OpenDental?

OpenDental keeps fee schedules in Setup, Fee Schedules, and does bulk work in Fee Tools, at the lower right of the Procedure Codes list. Version 24.4 added an effective date to Copy To, Import and Increase by % (see the 24.4 release notes and the current Fee Tools page). Other steps follow the public manual pages, written for 24.3, on Fee Tools and updating fees.

Increase by % suits one number for every code; Import suits fees decided line by line, from a tab-delimited file: code first, new fee second, no $ sign. With only the schedule chosen in Select Fees, Increase by % changes global fees only; select each clinic or provider with overrides for its own pass, in Import too. Codes left out of an import keep their fees, so run Increase by % first, then import the line-by-line codes, plus held codes at their current fee. The manual does not cover two dated loads on one code; test the sequence on a scratch copy first. Global updates need a direct database connection, not Middle Tier. If you honor this year's fees on treatment already presented, run Update Fees in each patient's Treatment Plan module as their grace ends, as the manual suggests, or, if the grace ends on a fixed date, one global update that day, by clinic if needed.

OpenDental's new year tasks pair adjusting fees with updating procedure codes, and the ADA's CDT page already links the Code Maintenance Committee's decisions for CDT 2027. Load new codes, then run the blank-fees report.

One fee schedule for the group, or one per office?

In OpenDental the billed fee follows a provider's schedule, not the office, and the fee schedule logic page recommends provider and clinic overrides over separate schedules. Clinic-specific fees need Use Global Fees turned off; see provider and clinic fee overrides.

In a group, set the target percentile once and let each geozip turn it into local fees. Run the sheet per office.

The single-office version

One office usually needs one schedule; the owner decides and the office manager builds the sheet. Review any other schedule a provider carries in Edit Provider, or comparing providers' production misleads.

What do you tell staff and patients?

The front desk and the treatment coordinator need the new fees, the effective date, one plain sentence ("Our fees are reviewed once a year, and the new fees started on the first of the year"), and the grace rule in writing: whether, and how long, treatment presented at this year's fees is honored.

Patients mostly notice when treatment presented before the change is scheduled after it. For a contracted plan, the patient's share generally follows the allowance, not your fee, so a PPO patient may see no change. Some networks accept fee filings; Delta Dental's multiple-office guidance allows Premier fee updates every 12 months per location, specialty and TIN, though not in every state, so file where that applies. Otherwise, changing an allowance is a separate project with each carrier, under that contract's terms; list any plan that looks out of line for whoever advises you on contracts.

What should you watch in January?

Gross production rises the day the new fees take effect, because it is booked at the office fee. Collections do not follow one for one: unless a carrier issued a new schedule or accepted a fee filing, contracted allowances did not change, so the difference lands in write-offs, and the gap between production and collections widens on paper. Watch these:

• Write-offs by plan. Contracted plans should rise; one that did not move may have something other than your new fee on its claims.
• Collection ratio on net production, per office. In a PPO-heavy office, write-offs absorb most of the increase, so it should hold steady; a drop beyond the usual January deductible dip may mean write-offs are not posting or claims are lagging. See our dental KPIs short list.
• Average fee billed for the top codes, per office and per provider. If it moved less than the increase, check for providers on the old schedule or grace-period plans.
• Goals and bonus tiers. A production goal set at last year's fees gets easier by the size of the increase; reset it, or the first bonus of the year pays for the fee change instead of the work.

Keeping score after the fees change

The harder part comes January through March: checking office by office whether production, collections and goals moved as planned. MyDentalForce integrates with OpenDental today and shows production, collections and goals per office and rolled up in Production Command. A billing team working claims across locations gets a cross-office billing worklist, which is a worklist and not full revenue cycle management.

Put the review on the calendar before year-end benefits calls fill it, and save the sheet for next year's reviewer. The review that happens every third year is the expensive one.