Do not carry a Houston reference into an Austin agreement
Austin-area services should be checked against the applicable Texas county/locality entry rather than automatically using Houston’s locality. For an owner with sites in both markets, separate each site’s formula and payer participation before building a combined revenue model.
- Which county is each Austin-area service site in?
- If your practice also operates in Houston, are the exhibits and participating networks the same?
- Do code volumes reflect Austin services rather than a combined multi-city total?
Prepare your Austin reimbursement baseline
Keep Austin and other Texas sites separate until the contracts and reference bases have been reconciled. Combine modeled gaps only after each site’s rates and volumes are matched.
Use permitted, deidentified summaries rather than patient-level records. Gather signed agreements, amendments, annual code volumes and applicable renewal deadlines. You do not need to upload these documents to request an initial conversation.
Provider resources in Texas
Texas Department of Insurance resources help practices identify provider payment and contracting issues. Keep a request to improve future rates separate from a dispute over an existing claim. If your schedule is Medicare-based, check the correct service locality and reference year before comparing cities.
Confirm the applicable plan, regulator and dispute process before relying on state guidance. Payment enforcement and a request for better future contract rates are different tasks; neither establishes an entitlement to a rate increase.
What a local comparison does not establish
Our online references are national screening figures—not verified local, state-specific or payer-specific offers. Match the code, modifier, date, network and professional or facility setting before describing a benchmark as local. Unsupported codes remain unbenchmarked.
Commercial contracts more than five years old are eligible for renegotiation screening, subject to their actual terms. A payer may decline a request. An opportunity identified, a signed rate amendment and payments verified after implementation are separate outcomes.
Official sources and further reading
- CMS Physician Fee Schedule locality key
Check the applicable year and service location. Medicare geography does not establish commercial negotiated rates.
- Texas Department of Insurance: health care providers
Official provider resources. Confirm whether the plan and claim fall within the department’s authority.
NPAG editorial review · October 13, 2026 · Sourcing and corrections