Transparency in Coverage Files for Small Practices

If you run an independent practice, Transparency in Coverage files are the first public source of your own payer rates. This guide explains what's in them and how to use them.

What the rules require

The Transparency in Coverage final rules (85 FR 72158) were published by the Departments of the Treasury, Labor, and Health and Human Services on 12 November

1. They require non-grandfathered group health plans and health insurers in

the individual and group markets to publish pricing information in machine-readable files.

Two files matter most:

• In-network negotiated rates: the rate the plan negotiated with each in-network provider, for each item and service.
• Out-of-network allowed amounts: billed and allowed amounts for out-of-network providers.

Plans must publish them for plan years beginning on or after 1 July 2022, and update them monthly.

What's inside an in-network file

Each file lists:

• the plan or plans it covers;
• billing codes, such as CPT codes for office visits and therapy;
• the negotiated rate for each code;
• the providers each rate applies to, identified by NPI and tax ID;
• details such as the place of service and how the rate is expressed.

So if your practice is in network, your negotiated rates for the codes you bill are in that payer's files, under your NPI or tax ID.

Why practices don't use them

The files were designed for software, not people.

• There are a lot of them. A large payer posts hundreds of files a month: Aetna posted 288 in-network files for September 2026, and Cigna 120 (as checked on 21 and 23 September 2026).
• They're compressed JSON. They won't open in a spreadsheet.
• They change monthly. A rate you read in March may differ in June.
• They're organised by plan, not by practice. Finding your NPI means searching many files.

That's why most practices have heard of price transparency but never seen their own rates in these files.

What they mean for a small practice

You can see your rates without asking. Instead of waiting weeks for provider relations, you can read what the payer itself published for your NPI.

You can compare payers. The same visit can pay very differently across payers. In September 2026 files, the middle published rate for 99214 ranged from $90.75 at BCBS Texas to $131.54 at Cigna. See what payers publish for 99214.

You can check what you're paid. Comparing published rates with your allowed amounts shows whether claims are paid at the agreed rate. See how to spot underpayments by CPT code.

You can spot changes. Because files update monthly, a rate cut shows up in the data even if no letter arrives.

You can negotiate with evidence. Knowing where your rate sits in a payer's range gives you a concrete starting point at renewal.

Limits worth knowing

• Coverage varies by payer. Some payers list few providers or few codes.
• Published isn't always paid. The files show the negotiated rate; claims can still be allowed lower. That's an underpayment, and worth checking.
• Medicare and Medicaid work differently. These rules apply to commercial group and individual coverage. Medicare and state Medicaid programs publish their own fee schedules.
• A $0.00 rate isn't a real rate. Some files list $0.00 for codes a payer doesn't price that way. RateBench shows those as "not priced", with the reason.

How RateBench uses these files

RateBench reads commercial payers' in-network files and finds the rates published for your NPI, and for Medicare it reads the Part B fee schedule for your pricing area. Today that's 66 payers: the local Blue plan in 49 states and DC, plus UnitedHealthcare, Aetna, Cigna, Ambetter, Oscar and Medicare. Every rate shows the file and month it came from.

You can build a fee schedule across your payers and get alerted when a payer changes one of your rates. Or start free: pick your payer from the payer list, or see payer fee schedules 2026, and look up your rates for six common codes.